Quality Improvement Plans in Healthcare
By Anita Jean
To help us achieve a quality health system and realizing excellent care for all, under the direction of Health Quality Ontario, hospitals, primary care providers, the home care and long-term care sectors are required to submit a Quality Improvement Plan or QIP on a yearly basis and to make this document and our progress publicly available.
Hospitals, primary care providers, the home care and long-term care sectors are also required to report on their progress and their plans yearly.Ideally the board of these organizations also gets a regular report on quality improvement initiatives as well.
There 6 quality issues in Quality Improvement Plans or QIP – effectiveness, patient centered, efficient, safe, timely and equitable. Under each issue, there is a selection of indicators, both mandatory and optional for each sector, which changes somewhat year to year.For example, workplace safety is a new mandatory indicator this year for all sectors, with mandatory reporting of incidents of workplace violence for the hospital sector.
There is some flexibility to choose and add some indicators as further evidence of quality improvement initiatives under each of the quality themes. There is an expectation for comparison to a benchmark or basic performance, to measure performance between similar providers. Targets are set for the year, progress is measured and stretch targets are set for the following year to aim at a better performance. In addition, the performance of some of these indicators is tied to performance for senior management in some sectors.
Typically a lot of consultation happens at many levels in organizations to identify the best indicators for their plan, especially for larger organizations. It is mandatory for the hospital sector to have consultation with their patients, a trend that is growing amongst other sectors as well. Advisory committees consisting of client and sometimes family members help service providers ensure that the care they provide is as centered around the client as much as is possible. We call this client centered care. Quality improvement initiatives are validated by consultation with client and families.
What are good indicators for quality of care? A lot of data is collected in the health care system. There are best practices, which if in place, should ensure that the system works as effectively and efficiently as possible. Though not perfect and all-inclusive measures, some of these indicators provide a fairly good assessment of performance.
For example, care would be effective during transitions if a client who is discharged from hospital would get a follow up appointment with their primary care provider within a week of being discharged. Scheduling an appointment within 7 days is the QIP measure of effective care for the primary care sector. Mandatory chart audits to see if the appointment did occur will be the quality check for the upcoming year’s plan. For the hospital sector, if care has been effective, lower hospital readmission rates is one of the measures for effective care.
Here is another example. Effective coordination of care would occur when clients with many chronic or high cost conditions would be identified and provided with additions supports such as those of a navigator and the development of a coordinated care plan. This is what occurs under the Health Link program. Typically this support is needed for 90% of all palliative care clients, 70% of all frail seniors, and 50% of clients with mental health or addiction issues. An individual with several chronic or high cost conditions may have many needs, many service providers involved, and perhaps unmet needs as well. By identifying qualifying individuals as Health Links clients, the additional supports can be provided for these clients.
Health Quality Ontario provides the oversight in the Quality Improvement Plans for health care providers in Ontario.Your health care provider’s Quality Improvement Plan is usually posted on their website if you are interested in finding out about their quality initiatives.
Anita Jean is Manager of Health and Social Programs at NorWest Community Health Centres.
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