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We are an independent health policy think tank that supports health system integration and quality improvement in home and community care in Ontario. |
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Does the way health-care providers are paid motivate change? Can incentives be aligned to support integrated care and improved patient experience? Is pay for performance, service-based, or blended models the way to go? What's worked well where, and why? Guided by leaders from inside and outside Canada with the experience and expertise to provide answers, about 100 front-line planners, health policy thinkers and decision-makers from Ontario will fix their minds on those issues April 26th during an invitational symposium, Tools for Change: Levers and Incentives for Integrating Patient Care in Ontario. The symposium, co-sponsored by The Change Foundation and the Ministry of Health and Long-Term Care, will focus on funding strategies, barriers and innovations to kindle ideas and alliances in Ontario and prompt recommendations for short and long-term objectives. Says Steini Brown, Assistant Deputy Minister, Health System Strategy Division: "We welcome this opportunity to partner with The Change Foundation to learn more and think more widely about innovations in provider payment, key to advancing Ontario’s overall health system reforms. The central question is: how do we get to a system of funding and incentives that best enables providers to achieve seamless, coordinated care for patients across all settings?" The symposium’s learned line-up (to be released later this month), will be moderated by Change Foundation research advisor Steven Lewis, and feature U.S. physician and former governor of Vermont, Howard Dean, author of Prescription for Real Health-Care Reform (2009). A speaker from the U.K. is also expected (TBC), as well as a host of home-grown health-care leaders. Six topical case studies, four from Ontario and one each from the U.K. and U.S., will be prepared for the symposium. The Ontario case studies will spotlight promising regional innovations with wider potential, including Peterborough Primary Health Care Services, the Timmins Family Health Team, North York Hospital, Central CCAC and the recently integrated St. Joseph’s Health System, Hamilton.
In your own words, what does good coordinated community care for clients mean to you? What would it look like? If you could change one thing to improve client care, what would it be? These questions - and many others - were put to 2200 community providers in surveys sent by the Foundation in late 2009/early 2010 to capture their frontline views on how to provide more integrated care in communities across Ontario. This work complements our earlier work (June 2008) probing patient/caregiver perspectives on navigating the system. Now, working with the Community Provider Association Committee and the Ontario Association of Community Care Access Centres, we’re handing the mike over to community health and support providers. Separate surveys target case managers and service coordinators and regulated health professionals including registered nurses, nurse practitioners, advanced practice nurses, registered practical nurses, physio and occupational therapists, speech language pathologists, dietitians, social workers, respiratory therapists, and pharmacists. We look forward to comparing how provider views on integration differ from patients’ perspectives and each other. Look for findings and analysis later in 2010.
Patients and caregivers everywhere are busy blogging, tweeting and building Web 2.0 communities to discuss their health-care experiences. As health-care leaders, providers, and advisors, how do we best tap this rich reservoir of real-time real-life stories to improve patient care? Can listening to patients’ social media commentary about their health-care experiences provide new low-cost/high-touch quality improvement (QI) opportunities and value? How do we responsibly integrate what we’re learning into existing QI efforts to complement policy and research on patient satisfaction? The Foundation has joined forces with another think tank, Health Strategy Innovation Cell, to find out in an intriguing project, Using On-line Patient Dialogue to drive health-care improvement. The project will develop and test emerging best practice guidelines on using social media to enhance QI and patient-centred care, and will produce an e-toolkit of case studies and informed discussion around lessons learned about the potential and limitations of social media to improve health care. Providence Healthcare is already on board. President and CEO Neil McEvoy: "Traditional patient surveys only tell us part of the story. We hope this project will show us how to listen in a more meaningful way to real conversations among patients and families sharing their insights and experiences about health care; we want to use that to help us make tangible, measurable improvements in the way we deliver their care." The project will be aided and abetted by a 11-member ginger council who will use their diverse skills and expertise in social media and health care to provide strategic advice to us. Change Foundation CEO Cathy Fooks and Neil Seeman, Director and Primary Investigator of the Health Strategy Innovation Cell, encourage you to share your stories about the social media policies and practices in your organization. Reply to the questions in We Want to take your Social Media Pulse. Send answers to info@innovationcell.com. Read the Invitation to Partner.
As readers might recall, last year the Foundation and The Commonwealth Fund (CWF) decided to put their minds and money together to co-sponsor a U.S. - Canada health policy exchange, focusing first on primary care reform. The inaugural international meeting on health-care quality, "Innovations in Primary Care" takes place next month in New York and will convene about 20 American and Canadian policy leaders. They will dive deep into what makes or breaks good primary care on both sides of the border and surface with common and discrete solutions to improve primary care - and the performance of our respective health systems. "The picture is clear and it isn’t pretty: the U.S. and Canada remain far behind other countries in providing quality primary care on many counts," says Change Foundation CEO Cathy Fooks. "That’s why we need exchanges like this - to identify what changes are possible and preferable, and where improvements could become permanent." The forum will focus on goals, best practices, quality measurement, culture change, and workforce and aging population issues. The group will also probe the CWF’s rich and respected cross-national comparisons on primary care and results from international surveys of chronically ill patients and primary care doctors. In addition to an impressive lineup of American speakers, including CWF president Karen Davis, U.S. Health and Human Services Assistant Secretary Sherry Glied, and leaders in the field, there is a strong contingent of Canadian primary care experts, including Brian Hutchinson, William Hogg, Heather Manson, Bonnie Brossart, and Ruth Wilson. Read the agenda and check our website in the spring for case studies on exemplary health systems and other papers commissioned for the exchange.
The Change Foundation's 2007-2010 strategic plan, Contemplating the way we change, Changing the way we think, set up the Foundation to shift from a granting agency to an independent health policy think tank. It carved out a new and narrower set of strategic directions focused on health integration and quality improvement, and laid out expectations for what we wanted to achieve under each of them. And now the Foundation is asking itself - and the health-care community - how it can best build on that plan to precipitate change that improves health-care policy, practice and the patient experience in Ontario. Change Foundation Chair Scott Dudgeon is heading up a Strategic Plan Renewal Working Group (fortified by board members Susan Pigott, Neil Stuart, and Sheila Jarvis) which is tapping the experience and acumen of an impressive sounding board pulled together to test our thinking as we deliberate on the development of our 2010 - 2013 strategic plan, targeted for delivery June 2010. Since December, the Foundation has conducted interviews, webinars and small group discussions with a diverse range of health-care leaders, planners, providers and patients who’ve provided excellent input on where we can make our mark - and make a difference in improving health care and the patient experience in Ontario. We will distill all this advice before testing a preliminary strategic plan.
While we're starting to get a clearer picture of the safety risks in Canada's acute-care settings, we're still largely in the dark when it comes to knowing how big a problem we have with patient/client safety in home care in Canada. To fill this gap, a number of organizations, including The Change Foundation, have partnered with CPSI to fund research that will reveal the scope of the problem. CPSI launched the research competition (RFA Patient/Client safety in Home Care in Canada) January 28th, (read the French version here).This is the first time - not only in Canada, but internationally - for major funding (up to $1.1 million) to be made available for researchers to study patient/client safety in home care. The sponsoring organizations are CPSI, the Canadian Institutes of Health Research (CIHR), Institute of Health Services and Policy Research (IHSPR), Institute of Aging (IA), Institute of Circulatory and Respiratory Health (ICRH); The Change Foundation; and the Canadian Health Services Research Foundation (CHSRF). "The Change Foundation is pleased to participate in this national effort which builds on our previous work and comes at a crucial time given Canada’s demograhics and growing demand for home-care services,”said CEO Cathy Fooks. "Without this commitment to identify the size of the challenge we’re facing, it would be difficult to make measurable and meaningful progress on improving safety in home care for the millions of Canadians who rely on it," she said. The research project will be completed over two years, and the sponsoring organizations have committed to sharing the results of this groundbreaking work widely, with a view to informing changes in policy, practice and behaviour in home-care settings. The application deadline is April 8, 2010 at 12:00pm MT. To find out more about the Patient/Client Safety in Home Care in Canada Request for Applications, see the Canadian Patient Safety Institute (CPSI).
We need a seismic shift in Ontario to make interprofessional care less incidental and more internalized and institutionalized so that patients get the integrated care they want and need, Change Foundation Chair Scott Dudgeon said October 27th during a speech to the 2nd Tri-professional Conference of Ontario Pharmacists, Physicians and Nurse Practitioners, Let's Open More Doors: One Vision, One Agenda. Read the speech or see it on video.
At last week’s HealthAchieve and Celebrating Innovations in Health Care Expo, The Change Foundation and The Health Strategy Innovation Cell announced a new leading-edge project to explore how providers could look (and listen) to online patient conversations to improve the quality and delivery of health care in Ontario. The project, called Using on-line patient dialogue to drive health-care improvement, will involve several Ontario health-care organizations interested in determining the feasibility and desirability of tapping online patient and caregiver perspectives to better understand and improve the quality of the patient experience. The project, which already has Providence Healthcare on board, will develop and test emerging best practice guidelines on using open-source social media to enhance quality improvement and patient-centred care, and will produce an e-toolkit of best practices, case studies, and informed discussion about the potential and limitations of social media to improve health care. The unprecedented use of emerging social media mechanisms (like Twitter™, blogs and Facebook™) has unleashed a flood of new peer-to-peer commentary and discussion generated by patients and caregivers. This rich, untapped source of patient and caregiver input is not yet integrated into existing quality improvement and/or care delivery frameworks despite prevalent claims that patient–centred care is a top priority. We believe that by using emerging technologies that sift through social media dialogue, health-care planners and providers committed to patient-centred care may learn something new about where and how to improve the quality of patient care. This effort would complement current patient satisfaction measurements and its examination could contribute something new to this quickly expanding field of research. As a health policy think tank with a particular interest in improving the patient experience, The Change Foundation is partnering with the Innovation Cell. The Cell’s focus is to track and analyze patient stories on the Web to better understand patient needs, wants and expectations. Together, we are looking for strategic partnerships with health-care delivery institutions at the forefront of the quality agenda. Click here to read more about the opportunities and challenges of using social media to improve health care, and here to download our invitation to partner.
Change Foundation CEO Cathy Fooks says her biggest lesson after 20 years in health care is the need to use good research well to talk convincingly to policy makers. One of the first Canadian health-care leaders to be profiled on the recently launched Medical Post Canadian Healthcare Network portal, Fooks talks about the importance of learning from the patient voice especially in the new era of social media, of engaging physicians from the get-go in health-care reform, and of gleaning integration lessons from other jurisdictions to expedite Ontario's unique approach in devolved health-care a la Local Health Integration Networks (LHINs). Says Fooks: "We want to look at issues through a different lens. …We want to take in the total patient experience, all the things that probably aren't seen by everyone who provides care to a patient. That can be quite a powerful story." Learn more about her career path and read her hard-earned insights in The Healthcare Interview: Veteran of health-care wars looks to adjust perspectives on reform on Canadian Healthcare Network.
After listening to elderly patients and caregivers describe what works -- and doesn't -- during the move from hospital to home or long-term care, and learning from an analysis of all the steps and decisions in those transitions (247 for hospital to home; 160 for hospital to long-term care), hospitals and community care access centres (CCACs) involved in a quality improvement project in two regions in Ontario have introduced changes to ease patient transitions and provide better value and better care. Patients applauded the impulse to improve and provided valuable input on key challenges during these life-changing transfers. Read about the issues raised - and the early efforts to address them -- in a commentary released today by The Change Foundation. It is a companion to two reports detailing the project, which was undertaken with the South East CCAC and Quinte Health Care and Toronto Central CCAC and Toronto Western. The reports highlight the need to improve communication, update information systems, streamline processes, and clarify roles and responsibilities and highlights changes made to date. The project, called Having Their Say & Choosing Their Way: helping patients and caregivers move from hospital to 'home', is funded by The Change Foundation in partnership with the Ontario Association of Community Care Access Centres. Read about the challenges facing patients and the health-care system during these key transfers - and the efforts to address them in a commentary released today by The Change Foundation and the Ontario Association of Community Care Access Centres. The commentary is a companion to two reports detailing the project, undertaken with the South East CCAC and Quinte Health Care and Toronto Central CCAC and Toronto Western. Report 1 "People's experience receiving home care after being hospitalized" and Report 2 "People's experience going to long-term care after being hospitalized" both highlight the need to address poor communication and inadequate information systems, faulty design and processes, and confusion about who is responsible for what. They also outline progress and changes made to date. Also read the news release.
In a commentary released today, The Change Foundation says that community engagement (CE) is an essential ingredient in implementing health-care change that is understood, accepted and supported in communities across the province. A look at community responses to health-care change across the province speaks to the need for the health-care community to get the timing and the tenor of its conversations with the public right. The Foundation, in collaboration with the Local Health Integration Networks (LHINs), started its own conversation with the Local Health Integration Networks (LHINs) last year, collaborating on a spring symposium and workshop, Community Engagement & the LHINs: Truth & Consequences. The symposium summary includes fresh data from a survey of LHIN officials taken before the symposium and shares the results of what surfaced from real-time voting on such critical questions as the priorities and audiences for community engagement. The symposium, which drew leadership from all the LHINs and featured CE experts (listen to audio clips and read presentations) facilitated discussion and group work, was held as the LHINs were planning how best to engage their communities in the development of their 2nd Integrated Health Service Plan, due the end of November. See also: North West LHIN honoured with International Public Participation Innovation Award - Share Your Story, Shape Your Care and www.EpicOntario.ca: Engaging People. Improving Care.
Welcome to the first installment of Integration Incubator, a periodic series of stories about promising initiatives to nudge us closer to health services built around the needs and realities of people and populations and drawing upon health professions who work across sectors (instead of at cross purposes!) We start with Ottawa’s Bruyère Continuing Care and the Perley and Rideau Veteran’s Health Centre proposed Village Saint-Louis Supportive Housing Project. It offers a fresh vision on integrating care for seniors - a topic explored in an earlier symposium co-sponsored by The Change Foundation and CPRN. The 'outside the box' Village is a mix of supportive housing, strong informal social networks and formal services across the health-care continuum, ensuring patients receive the right level of care at the right time. Bruyère took the lead because of its deep expertise in seniors' health care, and to help tackle systemic issues which will help such symptoms as too many alternate-level-of-care patients. If funding comes through, the welcome Village will be ready to house about 200 elderly by spring 2011. Read the feature with accompanying Q and A with Bruyère CFO, Daniel Levac.
Better health, better care, better value: At Aim for the Summit September 18, hosted by CHQI and The Change Foundation, senior teams from all 14 LHINs shared their early learning as they apply the three-fold Triple Aim approach to their mandates to improve population health through service integration. “I really have come to appreciate having a forum in which LHINs can share that is moderated by third party experts,” remarked James Meloche of the Central East LHIN. A week later, CHQI’s Leadership for Performance Excellence program held the first of three networking meetings. Executive teams at seven hospitals and two CCACs are using the 16-month action-based learning program to strengthen their capability to pursue quality as a core business strategy. CHQI is one of several partners delivering Ontario’s Emergency Department Process Improvement Program (ED PIP) which was in the news October 1 for its success in tackling wait times. Read all about ED PIP and other groundbreaking projects in CHQI’s first annual report.
When decision makers gather to tackle a difficult health-care issue – whether around the Cabinet table, in a health-care board room, or at a legislative committee -- how does the latest policy research shine amid a crowd of competing influences? And how do you ensure that the latest evidence will be shared and embedded into practice at the point of care? Read the sage advice from Dr. John Lavis, Canada’s Research Chair in Knowledge Translation and Uptake, and Dr. Paula Goering, Director of Health Systems Research and Consulting Unit, CAMH. Lavis and Goering presented at a symposium, Bridging the “Know-Do” gap hosted by The Change Foundation Sept. 23. Over fifty nursing leaders, Ministry of Health policy experts, and health-care KT practitioners attended the symposium, which was moderated by Change Foundation Chair Scott Dudgeon, with welcoming remarks by Vanessa Burkoski, Ontario’s Provincial Chief Nursing Officer. In addition to an animated discussion about how to overcome barriers to effective KT and implement strategies to create a more evidence-based policy-making culture in Ontario, the symposium showcased on-the-ground lessons from provincial nursing practice improvement projects funded by the Nursing Secretariat and supported by The Change Foundation from 2004 to 2009. The diverse projects ranged from an oncology framework for Advanced Practice Nurses to a website for street nurses. Interactive digital voting on current KT challenges and success strategies during an afternoon workshop sparked dialogue and revealed the group’s preferences and priorities. Change Foundation CEO Cathy Fooks offered closing personal reflections, reinforcing an organizational commitment to bridge the KT gap through ongoing collaborative research with reports and forums targeting Ontario decision-makers to raise the level of political and public discourse on health-care policy. Read Top lessons from knowledge translation symposium: Bridging the "Know-Do" gap (January 2010) and hear audio clips.
The one-day Toronto gathering of key health care leaders in end-of-life care also featured: Dr. Stephen Wetmore, President, OCFP, Julie Darney, co-chair of MOHLTC's End-of-life Strategy, Margaret Mottershead, CEO of the Ontario Association of Community Care Access Centres, Chris Sherwood, President, Ontario Palliative Care Association, and Charles Beer, a board member of the Hospice Association of Ontario.
Want to hear directly from some of the best go-to people in the country on how Ontario can advance integrated care for seniors? Tune in or download the latest video podcast interviews from The Change Foundation and Canadian Policy Research Network's (CPRN) roundtable. Read senior CPRN Research Fellow Margaret MacAdam's commentary, Slow but Steady Progress in Home Care Sector and listen to her video interview. Roundtable speaker Réjean Hébert, Dean of Medicine, University of Sherbrooke, Quebec, compares Quebec's internationally studied SIPA and PRISMA health integration projects for seniors. Katie Hill, Director, Home and Community Care Programs, BC Ministry of Health Services, explains BC's Integrated Health Networks creating new collaborations between family physicians, nurse practitioners, health professionals, and community agencies to better coordinate care. The interviews offer insight and advice for Ontario policy makers on how to improve integrated care for seniors, many with chronic conditions, as they move between hospital, primary and community care and interact with an array of health services and providers. Tune in to tune up. The invitational forum built on CPRN Senior Research Fellow Margaret MacAdam's paper, Moving Toward Health Service Integration: Provincial Progress in System Change for Seniors (May 2009).See photos from the event.
The Change Foundation is delighted to report that it is partnering with the prestigious American health policy think tank, The Commonwealth Fund, to co-sponsor a series of Canada-US health policy conferences. The first forum, slated for the spring of 2010 in New York, will concentrate on "Innovations in Primary Care Policy and Delivery Systems." The two-day meeting will convene approximately 30 American and Canadian senior political and policy leaders to compare health system performance in the two countries, analyze shared challenges, and provide a platform for cross-national exchange of ideas on strategies to achieve a high performing health-care system. Said The Change Foundation President & CEO Cathy Fooks: "This inaugural collaboration can help establish a cross-national dialogue on primary care, looking at the challenges each system faces with an aim to identify policies and strategies to transform primary care to more integrated care, compare the range of available policy levers, and consider overall implications for quality and costs. We appreciate the confidence The Commonwealth Fund has shown in The Change Foundation, and we look forward to fostering our relationship over the years to advance solutions to improve the quality of our health-care system." Papers and case studies commissioned for the meeting will be prepared and revised for publication. It is expected that insights gained from the meeting will inform and help catalyze US and Canadian thinking on health-care reform.
A new Chair for The Change Foundation and fresh talent joined an already strong Board of Directors in June at the Foundation's AGM. See the new board line-up with Larry Chambers and Susan Pigott and new Chair, Scott Dudgeon. The board will work with CEO Cathy Fooks as the Foundation rolls out an ambitious work-plan for 2009/2010 and develops a strategic plan for 2010-2013 that builds on Contemplating the way we change, Changing the way we think (2007-2010). We'll put together an external sounding board from the health-care community to help us hone our thinking. Complementing this central planning is a parallel website review exploring options for greater online coherence and interactivity with our audiences. On the QI front, the Foundation will build on a current research partnership on home and community care with University of Waterloo researcher John Hirdes to produce information and analysis in 2010 on the needs and pressures of informal caregivers in our system. Building on our Having Their Say, Choosing Their Way partnership with OACCAC mapping the hospital-to-home transition, the Foundation will focus on building QI capacity in the community for the elderly with chronic diseases. The Foundation will soon be announcing the parameters of a new project with the Canadian Patient Safety Institute on adverse events in home care. See our previous work in this area with Paul Masotti.
Ready, set and Aim for better QI. On September 18, The Change Foundation and CHQI will host the invitational AIM for the Summit: Better Health, Better Care, Better Value targeted at LHIN leadership and staff and Ministry of Health staff. The event builds on last winter's Institute for Healthcare Improvement (IHI) Triple Aim conference in the US attended by over 30 LHIN leaders. The follow-up Toronto event is designed to embed QI learning into Ontario health system planning and integration processes. Participants will hear about the value of the Triple Aim framework from international experts with local examples from three leading LHIN early adopters. "This event will help Ontario leaders start connecting LHIN mandate and priorities with the framework's core principles of patient experience, cost per capita, and population health," says CHQI Executive Director Paula Blackstien-Hirsch.
June 23, 2009
Change is afoot at The Change Foundation board with recent role and responsibility shifts after our June AGM. Longstanding board member Scott Dudgeon takes over as Chair from Gail Donner who continues on the board. Dudgeon is past CEO of the Alzheimer Society of Canada and an experienced health-care executive. Sheila Jarvis becomes Chair, Elect and Neil Stuart takes over as Treasurer from money-man extraordinaire John Hudson. "I am deeply grateful to Gail and John for their smart, sensible and strategic start-up contributions crucial to setting us on a solid future course," says Change Foundation CEO Cathy Fooks. Larry Chambers and Susan Pigott join The Change Foundation's board. Chambers is President and Chief Scientist, Élisabeth Bruyère Research Institute, a Bruyère Continuing Care and University of Ottawa Partnership, and Pigott is Vice President of Communications and Community Engagement, Centre for Addiction and Mental Health (CAMH). "We welcome the individual strengths of both of these respected leaders. Larry brings valuable health research leadership in such areas as healthy aging and Susan adds diverse executive leadership in community service and a wealth of experience and connections from community engagement and public affairs. We will rely on their unique expertise as we renew our next three-year strategic plan and develop new projects to support Ontario's health integration efforts," says Chair, Scott Dudgeon.
Home care is a hugely important part of the continuum of care for Ontario patients -- a welcome and cost-effective substitute for hospital and long-term care within an integrated system of care -- but it's often ignored and under-resourced. Change Foundation CEO Cathy Fooks opened with those remarks as she delivered the keynote address at the Ontario Home Care Association's (OHCA) May 28 Symposium and AGM - Home Care - a solution to today's health system challenges. Attended by over 100 Ontario health-care leaders, including Health and Long-Term Care Minister David Caplan, the event focused on how home care can help address key provincial health priorities including expanding family health care and decreasing emergency room visits. Fooks shared results from The Change Foundation's research and quality improvement projects, including findings from Who is the Puzzle maker? report and the OACCAC /Change Foundation QI project, Having Their Say & Choosing Their Way. Both highlighted ways of improving patient care through better communication and coordination across Ontario's services and providers, especially at key transition points. Read the powerpoint presentation Why we care about Home Care or visit the symposium here.
Ontario needs to expand public voice and choice, engage physicians and other providers in reform and e-health, and develop funding and incentive models to better integrate primary and secondary care. These are just some of the key policy lessons Ontario can learn from England's National Health Service (NHS) according to The Change Foundation's new report: Integrated Health Care in England: Lessons for Ontario, the first in a series of international case studies drawing instructive lessons from other systems. The report offers system-level advice to Ontario's health-care leaders in six digestible sections and concludes with ten key integration ingredients. "I congratulate The Change Foundation on an excellent report. It covers a lot of ground and history and truly reflects the challenges that both jurisdictions face which are very similar," says Tony Woolgar, a former CEO of an NHS hospital and a former LHIN CEO asked to respond to our report because of his rare bi-national experience. Read Woolgar's commentary and listen to his wide-ranging Q & A video podcast. Download two related charts. The report was also reviewed by Chris Ham, Health Services Management Centre, University of Birmingham, and David Knowles, Kings Fund, London UK. Read a thought-provoking Q and A by third reviewer Jamie Burn of the Policy Exchange (see below.)
If you want to know what's really going on, you ask a local. In this case, we turned to a very in-the-know NHS guide, Jamie Burn, to give us a contextual overview of the strengths and weaknesses of that system's reforms under former prime ministers Margaret Thatcher (1979 to 1990) and Tony Blair (1997 to 2007). Burn is a former research fellow at England's respected Policy Exchange and one of the report's three reviewers. He holds an MSc in Social Policy and is completing a PhD in Health Service Management. Among our queries: What accounts for the greater willingness of England's National Health Service (NHS) to experiment and change? Read Jamie Burn's considered and comprehensive Q & A, Health System Reforms in NHS England: Context, Culture, Power, a companion piece to our new report Integrated Health Care in England: Lessons for Ontario. Download related charts.
The June 16, 17th 2009 invitational Meeting of the Minds, First things first: fostering accountable, connected, and quality primary health care, tackles a tough topic, but you can see from the program that we're putting some fine minds to it. The event opens with an evening debate between Emergency physician and broadcaster Brian Goldman and Champlain LHIN CEO Robert Cushman about whether the LHINs should have authority over primary health care. The next day feature presentations and discussions about how jurisdictions inside (BC/QC) and outside (UK/US) Canada have brought primary health care into the fold to good effect. A summary report will be prepared and shared. See report from Meeting of the Minds 2008.
Improvements in length of stay, ALC days for patients, and greater collaboration between physicians and other health providers are some of the promising outcomes reported in CHQI's wrap-up report: The Flo Collaborative: Quality Transitions for Better Care. The project focused on improving the quality of care and health-care experience for patient “Flo” as she moved from acute care to her next setting. The report summarizes key collective and collaborative learning from its first large scale 16-month quality improvement effort involving 46 organizations in 29 partnerships with Community Care Access Centres (CCACs), acute care hospitals, and rehabilitation and complex continuing care facilities. While the project ends, QI efforts continue through local Improvement Advisors and other senior leaders. LHINs will be actively engaged in this “spread” through new regional partnerships. Read the executive summary and full report.
2007/2008 was a critical set-up year for The Change Foundation as we put our thinking to good use -- with good input, good will, and good wishes from Ontario's health-care community. We carved out research agendas to support health integration and quality improvement in home and community care, then got to work, attaching projects and people and products to them. We've made a solid start of many of those efforts, and we encourage you to find out more by scanning our annual report. It takes time and talent to deliver quality and excellence, but we think we're On Track to do just that. See where we've been, and read where we are headed.
Foundation-funded Hirdes' project illuminates home and community care challenges - adds evidence to ALC strategy & boosts understanding of chronic disease management in frail elderly. The study's first focus is on the clinical and social needs of ALC patients waiting in acute hospitals for long-term care (LTC). Analysis of ALC discharge to LTC indicates that the classification is not always driven by clinical need. Early evidence from Dr. Hirdes' Foundation-funded work mining a rich database using the International Resident Assessment Instrument for Home Care (interRAI-HC) data has already been put to good use. Dr. Hirdes has presented these findings as part of Dr. Alan Hudson's ER-ALC strategy tour to LHIN leaders, CCAC directors and other decision-makers across the province who are seeking solutions to this system-wide problem. Watch and listen to the podcasts.
How can Ontario improve the coordination and continuity of care for seniors, many of whom have chronic conditions, as they move between hospital, primary and community care and interact with an array of health services and providers? Research tells us that certain models of care keep seniors healthier without adding costs. What are those models? What can Ontario learn from other jurisdictions and what does it do well already? These are just some of the big picture questions to be debated during a Feb. 25th roundtable co-hosted by The Change Foundation and Canadian Policy Research Networks (CPRN). The roundtable brings together some of the best, most forward-looking minds on geriatric health policy from across the country with a special focus on initiatives in British Columbia and Quebec. The diverse gathering will draw senior policy decision-makers in Ontario, drawn from the Cabinet and Premier's Office, health sector associations, LHINs, CCACs and provincial ministries across Canada. Roundtable discussion will be based on a paper (final version to be released this Spring), Moving Toward Health Service Integration: Provincial Progress in System Change for Seniors (February 2009) prepared by CPRN Senior Research Fellow, Margaret MacAdam with funding from Ontario's Ministry of Health and Long-Term Care. The report includes a literature review and the results of a survey of provincial progress in implementing the features of integrated care systems (based on the respected Hollander Prince Framework for organizing continuing care services.) MacAdam's work shows that while every province has made public commitments to providing integrated care, progress is uneven, and some features are not well developed by any jurisdiction. Read the related CPRN report Implementing Integrated Care Frameworks of Integrated Care for the Elderly: A Systematic Review also by Margaret MacAdam. Read the program and stay tuned this spring for a summary report from the round-table with policy recommendations for Ontario.
Community engagement (CE) is not just a legislated requirement for Local Health Integration Networks (LHINs) and health service providers, it is also an important lever to transform health care. That's why The Change Foundation is partnering with the LHINs to host an interactive, invitational symposium and workshop, Community Engagement & The LHINs: Truth & Consequences, on March 11th in Toronto. Targeted to LHIN CEOs, Board Chairs, senior LHIN staff/CE Leads, the program will feature experts in CE research and practice such as Julia Abelson of McMaster University and Peter MacLeod from Mass LBP, as well as a panel of LHIN CEOs Gwen DuBois-Wing and Paul Huras. The symposium/workshop is being offered at an opportune time as the LHINs plan how to engage their publics in the development of Integrated Health Service Plans for 2010-2013. The afternoon workshop will build on and expand participants' CE expertise, showcasing useful models, tools, tips, case studies, and applying past experience to current priorities and challenges. To reflect realities in the field, the day will incorporate the LHIN CE priorities and experiences identified in a pre-event survey. Read the program and look for a report summarizing key learnings from Truth & Consequences on our website this Spring.
Our bodies may be more sedentary in winter, but our brains don't have to be. Continue to exercise your cranium by taking our February acrostic challenge. Once completed, the puzzle reveals a quote connected to our research collaboration with Dr. John Hirdes of the University of Waterloo and Homewood Research Institute on better understanding ALC patients and chronic disease management for seniors with Congestive Heart Failure.Hear his podcast here. To get started, download the acrostic software and fill out the puzzle. (See completed sample from last time here) The first person to send in completed puzzle will receive a $40 Chapters gift certificate. Look for the completed February crossword on our website on Monday March 9th.
The Change Foundation talks to Dr. John Hirdes about two-year collaborative study with The Change Foundation, using rich interRAI data to probe Ontario's ALC population and chronic disease management in the frail elderly. John Hirdes (video bits & bytes) on:
See the whole video podcast.
Despite the growing demand for safe community care, we don't know near enough about adverse events (AE) in homes and community settings across Canada (we don't even have a standardized definition). That's why The Change Foundation is supporting research to help remedy this gap and identify changes to policy and practice that can help prevent adverse events in the community. Learn more in an article, "Adverse Events in Community Care: Implications for Practice, Policy and Research" by Paul Masotti, Michael Green and Mary Ann McColl, in Longwoods Healthcare Quarterly (published January 13, 2009 and available online and in hardcopy). The paper is based on results from an April 2008 symposium funded by The Change Foundation in partnership with Queen's University's Centre for Health Services and Policy Research and the South East CCAC. During the symposium, 31 professionals from 18 organizations with expertise in home-care services, administration, primary care, patient safety, health policy and research discussed changes to policy and practice to enhance patient safety and identified further research to inform analysis and evidence-based decision-making. The Foundation plans to build on this learning to define future work.
"Ross Baker and his colleagues have written a fine text on High Performing Healthcare Systems - Delivering Quality by Design. It is well researched, well written and well timed for our Canadian health care system. It should be read by anyone interested in the pursuit of high quality health care, particularly in our larger health care organizations and enterprises. It should also become required reading in our health care administration, medical, informatics, and health professional academic programs across the country." So writes Prof. Denis Protti's (U. of Victoria's School of Health Information Science) in an online review on Longwoods of High Performing Healthcare Systems - Delivering Quality by Design. (Read the full review here or download a PDF) The book, published by Longwoods and launched last October at an event sponsored by HPME at the University of Toronto and The Change Foundation, distills key learnings from case studies of high performing health care systems from around the world. It presents seven case studies (five from abroad and two from Canada) of organizations that have demonstrated high quality results through a mix of good incentives, clear goals, effective accountability systems, sound information management and technology practices and the constant application of quality improvement techniques. Delivering Quality by Design grew out of a conference last April organized by OHPI, the predecessor of The Centre for Healthcare Quality Improvement (CHQI) at The Change Foundation. Learn more about CHQI at The Change Foundation's Quality by Design projects. |
    
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