Monthly Bulletin of the Alliance's Learning Health System |
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Six Potholes to Avoid in Quality Improvement |
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Examining Health System Reform |
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Register Now for Our Annual Conference |
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Learning Events & Programs |
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Get Involved: Research & Sharing |
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Your Quality Improvement Journey:
Six potholes to avoid
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It’s spring in Canada, and spring means potholes. Whether you’re walking, riding, or driving, an unexpected pothole in your path can cause anything from a momentary distraction to a major disruption in your journey. This is also true in quality improvement (QI), where our progress can be seriously impeded because we fail to avoid these tire-popping, ankle-twisting, axle-breaking traps. Here are six common potholes that cause teams to stumble on their QI journey, and how to avoid them. |
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Not having the right group of travellers. An effective QI team needs a strong leader and someone who can help interpret the data. It also requires representation from each part of the organization that will be affected by the changes, whether as decision-makers or as staff who may be called on to identify, test, and implement changes. Consider inviting a client or community member, too.
Not having a shared understanding. The team might not agree on donuts vs. bagels at meetings, but they need to be traveling the same path, in the same direction, at the same pace. This means they need to be aligned when it comes to the issues being addressed, the goals of the project, and the importance of the journey.
Not having a SMART aim. In quality improvement, it’s important to have clear goals we can progress steadily towards (and know when we’ve reached them). SMART stands for Specific, Measurable, Attainable/Actionable, Relevant/Realistic, and Time-bound. You need to know where you are going; why you are going there; that you can, in fact “get there from here;” when you expect to arrive; and how you’ll know when you have.
Not understanding the root cause of the issue. Root-cause analysis is an essential step on any successful QI journey. It means digging deep – asking why, and why, and why again – to understand what really needs to be addressed, in order to make meaningful, lasting change. Missing this step can mean addressing something that’s really just a symptom of a deeper problem or a side-effect of a previous intervention.
Skipping the P in PDSA. The P in PDSA stands for Plan, but it also stands for Purpose and Prediction. We need to choose change ideas that address root causes and are grounded in a theory of change. A PDSA is a learning tool – a method for making and testing predictions. Through small-scale tests of change and ongoing measurement of processes and outcomes, we refine and evaluate our predictions and make evidence-informed decisions. When we skip the planning stage, we risk making hasty changes without purpose or prediction.
Misinterpreting the run chart. A run chart demonstrates the impact of our improvement efforts. An effective run chart tracks our measures not just before and after a change idea is implemented, but all along the way. A clearly annotated run chart with measurements taken at regular intervals is essential for understanding and learning from the patterns in our data.
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When you’re new to structured quality improvement work, steering clear of these potholes isn’t easy. Working with a trained QI coach or practice facilitator and travelling with a group of like-minded peers can help. This spring, the Alliance is offering our members an opportunity to engage in supported, structured quality improvement in our second learning collaborative. Participating teams will improve how they collect and record sociodemographic data to ensure that it’s clinically and strategically relevant for advancing health equity. At the same time, they will develop their QI knowledge and skills, so they’ll be equipped for more QI journeys to come. |
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Interested?
Want to know more about it?
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Examining Health System Reform
A Veteran of the CHC Movement Examines What Matters
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Ontario Health Teams (OHTs) were introduced three years ago, in February 2019, with a goal of reforming the health system – specifically, by advancing fiscal sustainability and integration. Russ Ford was the CEO of Stonegate CHC for 10 years and LAMP CHC for 17 years. He is currently pursuing a PhD in social work at McMaster, focusing his research on health system reform. Ford shared with EPIC News some of his early observations on OHTs, health equity, and what reforms he believes are really needed.
What’s not really broken: Health system sustainability and integration
Ford argues that government claims that the health system is unsustainable unsustainability are based on strategically (and misleadingly) chosen data. Those arguing for system reform often point out that healthcare spending has increased as a portion of the budget. However, Ford counters that this is simply an artefact of lower spending in other public services. When measured as a proportion of the GDP, healthcare spending in Ontario has remained constant over the last decade.
Regarding system integration, he acknowledges that there is room for improvement. People with barriers to care are more likely than others to fall through the proverbial cracks. However, he notes that according to a 2015 study by the Commonwealth Fund, 90% of respondents in Ontario said they knew who to contact when leaving hospital if they had a question about their treatment, putting us on par with other countries in the survey. Similarly, 82% say their regular primary care provider helps coordinate their healthcare. Moreover, Community Health Centres and other primary healthcare organizations that operate on a similar model provide integrated care and system coordination for clients who need it most. The health system, he argues, may need tweaking, but not an overhaul.
The reform that’s really needed: Getting OHTs to commit to advancing health equity
OHTs have developed against the backdrop of a global pandemic, impending environmental collapse, and surges in homelessness and substance-related deaths. Each of these intertwined crises undeniably has an outsized impact on systematically marginalized people. Meanwhile, high-profile incidents of police violence have animated the #BlackLivesMatter movement; and the discoveries of hundreds of Indigenous children’s bodies at the sites of former residential schools have brought the legacy of colonialism into sharp relief. All of this has brought national attention to the disparities underlying barriers to health and wellbeing, and this presents a unique opportunity for OHTs to pursue a different kind of system reform – advancing health equity.
As part of his research, Ford has followed the progress of OHTs and their effectiveness in advancing health equity at the local system level. As of January 15, 2022, 37 of the 50 OHTs had websites which name the partners and describe the OHT’s commitments. Of them, Ford makes the following observations:
- 26 include CHCs as partners. 12 of these define health equity as a priority; 9 others mention equity; and 5 do not mention equity at all.
- 11 do not include CHCs as partners. None of these define health equity as a priority; 1 mentions it; and 10 do not.
This association between an OHT having at least one CHC partner and expressing a commitment to health equity suggests that CHCs are making an important impact on the shape of health system reform. Nevertheless, some share a sense that they are swimming upstream. Ford refers to personal communication in which CHC leaders tell him they’ve raised health equity as a key issue at OHT tables but not found buy-in from the partners. A provincial mandate for OHTs to prioritize health equity would be a helpful push towards meaningful health reform.
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Action Now! Building Equitable Futures Together
Registration is Open for our Annual Conference
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After being cancelled in 2020 and held virtually in 2021, the Alliance's annual conference is once again being held in person! This yearly learning event is a place for our members and partners to connect and share promising innovations, discoveries, and advocacy.
This year's theme is Action Now! Building Equitable Futures together. Throughout the pandemic, longstanding inequities were laid bare, as COVID-19 had an outsized impact on marginalized communities and those who experience deprivation and isolation. Now is the time to correct them. Recovering to the status quo is no recovery at all.
This year's learning sessions are organized around eight major themes/streams:
Governance, including the Governing For Health Equity training modules and presentations about Ontario Health Teams and the board's role in the return to the new normal.
Black Health, featuring presentations from clinicians and staff at Women's Health in Women's Hands CHC, plus special presentations on the new Black Health Strategy and Black health planning & partnerships.
Harm Reduction, featuring practice spotlights on safer supply programs, intersectional stigma, and care for sexual health, plus a special, in-depth discussion of the future of safer supply.
Population Health, featuring workshops and panels about strategies to prevent adverse childhood experiences, advancing socio-demographic data collection in rural settings, building learning health systems, and counteract the impacts of stigma on health.
Indigenous Health, with in-depth presentations on Indigenous practices in community health and the connection between traditional healing and mainstream health care.
Digital Equity, Digital Health, and Data, where we'll learn about best practices for virtual health care, privacy, digital equity, and using artificial intelligence to better understand our client populations and their health.
Equity Strategies, all about the need for more investment in CHCs, the importance of equity in accreditation, talking to the media about health equity, and practice spotlights on a handful of interesting equity-advancing initiatives within our sector.
Plenary sessions are still being finalized. We are will be showcasing panels and keynote speakers with experiential and professional expertise about health equity and sovereignty for marginalized populations, including Black, Francophone, Indigenous, and 2SLGBTQ+ people and communities. Of course, there will also be poster displays and exhibits, and plenty of time to check them out. Fill your conference passport for a chance to win a prize!
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Learning Events & Programs |
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March
March 26, 1:00-3:00pm - UPHNS Hub Training: Trauma-Informed Care in Overdose Response Work. Participants will learn about what trauma-informed care is, how the trauma-informed overdose response curriculum was developed, and discuss practical strategies based in preferred community-practices of overdose response, including the trauma-informed overdose response curriculum project developed with people who use drugs through the Moss Park Consumption and Treatment Service in Toronto. Register here. Limited to 55 participants. For more information, email Nabila Basri.
March 31, 12:00-1:00pm - MyPractice Primary Care Report: Using Data for Improvement. This webinar from Ontario Health will guide you in using the data in your My Practice: Primary Care Report to improve patient care. Physicians who participate can earn MainPro+ CME credits. Register here. See the flyer here in English or French.
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Please note: The MyPractice reports are created by Ontario Health and ICES for FHTs, FHOs, and similarly structured primary care teams. The equivalent data for CHCs and AHACs can be found in the Practice Profiles, which are created by the Alliance and ICES using linked EMR and administrative data. This Alliance webinar on April 12 has been specifically developed for CHCs using Practice Profiles.
April
April 4, 3:00-4:00pm - Wound Care Workshop for Non-Clinicians. This webinar is hosted by the National Safer Supply Community of practice; it's a public event and everyone is welcome. Closed captioning and French written transcription will be provided. Register here.
April 12, 12:00-1:00 pm - Lunch 'n' Learn Webinar: Understanding Your Practice Profile.
Join us on Tuesday, April 12th for a sector Lunch and Learn about the new practice profiles. Quality Improvement & Performance Leads Kendra Jones, Stephanie Bale, and Jennifer Sarkella will review key trends in the 2021 data and orient staff and providers to the new and refreshed format. Following their presentation, we will have plenty of time for questions and discussion. We encourage you to share this with any relevant staff at your centre. More information here. Register here.
June
June 10 - Scaling Up Safer Supply - Ontario Regional Meeting. Join Ontario members of the National Safer Supply Community of Practice at this one-day knowledge-sharing session in Toronto. We will address the future of safer opioid supply from various perspectives in both plenary and small-group sessions. Additionally, there will be opportunities for informal discussions. Registration and information here. Free to attend. Note: For those who plan to also attend Action Now! Equitable Futures Together on June 8 and 9, you can book your hotel at the same time and the same rate, subject to room availability.
Ongoing
Governing for Health Equity Training. This five-part online course was created by the Alliance to help boards go beyond diversity and inclusion, and build organizations that are better equipped to advance health equity at every level in the organization, the community, and the health system. Self-paced. Discounts for Alliance members and health equity builders. Register here.
website to learn more and sign up your team.
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Research & Sharing Opportunities |
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Clinical Trials & Studies
Predictors of Alcohol use and Consequences in Transgender adults (PACT) Pilot Study: The Clinical Addictions Research and Equity (CARE) Lab at Ryerson University is recruiting participants for a pilot study examining patterns and predictors of risky alcohol use among transgender individuals. They are seeking participants who are 19+, identify as Transgender, live in Canada, drink alcohol regularly, and own a smartphone. Participants will be compensated. For more information, see the flyer, visit the study website or email the CARE Lab.
I’m Ready: a national HIV self-testing research program. I’m Ready is a national HIV self-testing research program from REACH Nexus. Using a secure mobile app called I'm ready, Test, they're distributing 50,000 free HIV self-testing kits across Canada and learning from the experiences of people who use them. Participants can get connected to resources and care through a new telehealth service called I’m Ready, Talk. Anyone interested in participating can get started by downloading I'm ready, Test, which will walk them through the consent process, or contact the research team at reachnexus@unityhealth.to. Partners in the project include the Canadian Foundation For AIDS Research; Women’s Health in Women’s Hands CHC; The Canadian HIV/AIDS Black, African and Caribbean Network; and the Community-Based Research Centre. You can follow I’m Ready on Twitter, Facebook and Instagram at @ImReadyJagis.
Help advance equity in preveintive primary care across sectors. Researchers from Women's College Hospital and MAP Centre for Urban Health Solutions have multiple projects underway to help advance equity in preventive care, including screening for cancer and cardiovascular disease. Here are two opportunities for clinicians and interprofessional providers to share their expertise. Please share them with tyour primary care colleagues!
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Support the development of an e-learning module for equitable lung-cancer screening: A research team led by Dr. Ambreen Sayani and Dr. Aisha Lofters from Women’s College Hospital is looking for clinical and interprofessional providers at CHCs, AHACs, CFHTS, and NPLCs to help them build a trauma-informed and equity-based e-learning module for family physicians. Flexible scheduling is available to accommodate busy clinic schedules. See their letter of invitation for more details. Email Dr. Ambreen Sayani if you have questions or want to participate.
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Join a panel that would make recommendations to promote equitable access to preventive care interventions during the pandemic recovery period. Aisha Lofters from Women's College Hospital and Nav Persaud from Unity Health are seeking participants for this panel, which will help inform the development of revised clinical practice guidelines. They are prioritizing racialized women and others who are typically underrepresented in such panels; primary care experience is an asset. Apply here.
Tailored messages about COVID-19 vaccines for your hesitant clients: The Canadian Primary Care Information Network (CPIN) is looking for physicians and NPs to participate in a study that will use the CPIN platform to communicate with clients who feel hesitant about the COVID-19 vaccines. Participating providers will receive CPIN services free for one year and will be compensated for their time. For more information, see the research flyer (English and French) or email the study team.
Share your experiences working with uninsured migrants. Researchers want to hear from health care providers who have experience providing services to uninsured migrants. What they learn will inform policy recommendations and will be shared through community events. Confidential interviews will be conducted over Zoom. Email Melissa Anderson to participate or learn more.
Seeking people who have been impacted by long COVID. Researchers from the Bruyère Research Institute (Ottawa) and St. Michael’s Hospital (Toronto) are studying the effects of long COVID, how it impacts health equity, and what policymakers can do to prevent and manage it. People who have long COVID, think they might have it, are a caregiver to someone who has it, or are part of a community that has been impacted are invited to join their Advisory Committee. Participants will be compensated. See the recruitment flyer here for more information about the study and how to participate.
Collaborative Learning
Advance Health Equity with Meaningful Sociodemographic Data. In 2021, Alliance members voted unanimously to advance sociodemographic data collection in our sector. Fulfilling this commitment will be an important step towards advancing health equity in our communities, because good sociodemographic data supports equity-oriented decision-making at all levels - individual, community, and system. To help our members meet this commitment, the Alliance is preparing data snapshots for each centre and a toolkit full of case studies and change ideas from our sector. We are also hosting a learning collaborative to launch this spring; participants will build their quality improvement muscles and apply them to meet centre-specific goals for better data collection. Watch for more information in the April edition of EPIC News, or contact Wendy.Bahn@AllianceON.org to sign up!
SPIDER Learning Collaborative: De-prescribing dangerous medications. Can data-driven QI activities help de-prescribe potentially harmful medications, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.
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Guidance & Tools to Support Quality Improvement
Quality Standards Resources from Ontario Health
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New! Quality Standard on Transitions From Youth to Adult Health Care Services, developed in partnership with the Provincial Council for Maternal and Child Health. When young people transition from youth to adult health care, they are at increased risk for negative health outcomes as they adapt to new services, people, and processes. This new quality standard is an evidence-informed resource that can help young people, families, and caregivers know what to ask for in their care; health care professionals know what care they should be offering; and health care organizations measure and improve their performance in caring for these clients. Stay tuned for information on an upcoming webinar. For more information, contact qualitystandards@ontariohealth.ca.
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Recognizing World Delirium Awareness Day. Delirium is often a complication of respiratory illnesses, such as pneumonia, in older adults. It is a sudden change in how someone thinks, acts, or understands what’s happening to them. See the quality standard addressing what quality care looks like for delirium, plus accompanying patient guide, from Ontario Health and Provincial Geriatrics Leadership Ontario. More resources here.
The QIP Navigator is open now until June 30. This online tool allows health care organizations in Ontario to submit their annual organizational Quality Improvement Plans (QIPs) to Ontario Health. It is also a source for tools and resources to develop your QIP, and it includes a searchable database of all previously submitted QIPs. All organizations are encouraged to create a QIP for 2022-23 and post it on their websites; however, submitting it to Ontario Health is optional this year. Questions? Contact QIP@OntarioHealth.ca.
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Alliance Members: When choosing your annual improvement goals, consider using measures from the common QIP indicators developed by and for the community primary healthcare sector in 2018. For help with this, consult your Quality Improvement and Performance Lead (QIPL).
Support for your OHT's collaborative quality improvement plans: The Alliance hosted a special Lunch 'n' Learn webinar on January 18 to help primary care teams better understand Collaborative Quality Improvement Plans (cQIP) and work with their OHTs to develop their CQIPs for 2022/23. Check out the recording and slide deck here along with links to the guidance document and technical specifications, a cQIPs community of practice, and other helpful resources from Ontario Health. More Ontario Health resources for quality improvement in primary care are available here.
Recently Published Research
Report - Health of Canadians in a Changing Climate: Advancing our Knowledge for Action. The chapters in this report discuss relevant findings from the scientific literature on priority health risks related to climate change and on adaptation options for protecting health. It includes quantitative projections of future health risks from climate change; analysis of the interplay between climate change and important determinants of health, which can affect adaptive capacity and health equity to influence vulnerability to health impacts; and a separate chapter on climate change impacts on Indigenous Peoples’ health as well as information on on these impacts throughout the full report. All chapters include illustrative case studies of actions being undertaken by health authorities to reduce risks to Canadians from climate change.
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