Impressions and Observations 2015/16 Quality …

1 IN S IG HTS INTO Q UA LIT Y IMPROV EME NT. Hospitals Impressions and Observations 2015 /16 Quality Improvement Plans Let's make our health system healthier S. PITAL. HOS. About Us health Quality ontario is the provincial What We Do. Why It Matters. advisor on the Quality of health care. We We define the meaning of Quality as it pertains We recognize that, as a system, we have much are motivated by a single-minded purpose: to health care, and provide strategic advice so to be proud of, but also that it often falls short of Better health for all Ontarians. all the parts of the system can improve. We also being the best it can be. Plus certain vulnerable analyze virtually all aspects of ontario 's health segments of the population are not receiving care.

2 This includes looking at the overall health of acceptable levels of attention. Our intent at health Who We Are. Ontarians, how well different areas of the system Quality ontario is to continuously improve the We are a scientifically rigorous group with are working together, and most importantly, patient Quality of health care in this province regardless of diverse areas of expertise. We strive for complete experience. We then produce comprehensive, who you are or where you live. We are driven by objectivity, and look at things from a vantage point objective reports based on data, facts and the the desire to make the system better, and by the that allows us to see the forest and the trees.

3 We voice of patients, caregivers and those who work inarguable fact that better has no limit. work in partnership with health care providers and each day in the health system. As well, we make organizations across the system, and engage with recommendations on how to improve care using patients themselves, to help initiate substantial the best evidence. Finally, we support large-scale and sustainable change to the province's complex Quality improvements by working with our partners health system. to facilitate ways for health care providers to learn from each other and share innovative approaches. Insights into Quality Improvement Series Table of Contents Executive 4.

4 About This 5. 6. Chapter One: Overarching 9. Chapter Two: Working Within the Sector: Sector-Specific Advances on Priority 11. Indicator: Improving medication reconciliation at Indicator: Reducing C. difficile 14. Indicator: Balancing total 16. Chapter Three: Reaching Out and Working Together: Cross-Sector Improvements on Priority 18. Indicator: Reducing emergency department length of stay for admitted 18. Indicator: Reducing percentage of alternate level of care 22. Indicator: Reducing readmissions within 30 days of discharge to any 27. Chapter Four: Listening to Patients: Patient Satisfaction and 32. Indicator: Improving patient 32. Chapter Five: Moving 36.

5 Appendix: Data Ranges for Selected Priority 38. 42. health Quality ontario | Impressions and Observations 2015 /16 Quality Improvement Plans | Hospitals Executive Summary Insights into Quality Improvement Series Executive Summary There is a clear commitment to improving the care delivered in ontario hospitals. Hospitals have demonstrated this commitment by articulating improvement goals and targets in their annual Quality Improvement Plan (QIP), sharing it with their community, and submitting it to health Quality ontario . The April 1, 2015 submission marks the fifth year of making this formal commitment to Quality for all public hospitals in ontario more than 140 organizations in total.

6 The QIPs developed and submitted this year show that hospitals have integrated Quality improvement processes into their organizations and are working hard to implement best practices, while building relationships with system partners. Most hospitals (131) improved on at least one of the seven priority indicators, and 55 improved on three or more indicators. Hospitals are expanding their improvement strategies beyond the standard definitions of the indicators, such as extending lessons learned about antimicrobial stewardship into the community, and using top box scores to drive improvement on satisfaction. Hospitals are also taking a more proactive approach to capturing information about patients' experiences by using tools such as patient portals, providing surveys in different languages, and engaging patients and families in advisory councils and Quality committees.

7 At the same time, progress on most of the priority indicators has been slow. This may be because some of the indicators require work outside of organizations and are challenging to improve. The QIPs showed great variability in the indicators across the different hospital types and regions. To understand why some are performing better than others, it is essential to share the lessons from failures as well as from successes. This report is part of health Quality ontario 's ongoing Insights Into Quality Improvement series. In an effort to continue sharing information about strategies to improve care, it touches on all three components of the QIPs prepared by hospitals and largely concentrates on the lessons learned over the past year.

8 4 Hospitals | Impressions and Observations 2015 /16 Quality Improvement Plans | health Quality ontario Insights into Quality Improvement Series About This Report For the past five years, health sectors across ontario have developed and progress and identify areas in need of improvement is one way in which health submitted Quality Improvement Plans (QIPs). A process that began with Quality ontario works with the 1,076 health care organizations across four ontario 's hospitals has now extended to organized primary care organizations, sectors to transform the Quality of care throughout the health system. community care access centres (CCACs) and long-term care homes.

9 health Quality ontario hopes that the findings in this report will help inform The annual submission of QIPs demonstrates the ongoing commitment of more decisions about the Quality of care delivered in hospitals, encourage further than 1,000 health care organizations to deliver higher Quality care in ontario . testing of innovations and help to guide planning efforts for the coming year. These plans allow organizations to articulate their Quality objectives, formalize their improvement activities and pinpoint precise ways of achieving those goals. Each QIP details an organization's work on a set of priority indicators. These This report is part of the ongoing Insights Into Quality Improvement indicators align with the Common Quality Agenda, a set of more than 40 series.

10 It touches on all three components of the QIPs (progress indicators developed collaboratively by health Quality ontario and other report, narrative, and workplan) prepared by hospitals and largely health system partners. The Common Quality Agenda is an effort to focus concentrates on the lessons hospitals learned over the past year. performance reporting, lend greater transparency and accountability to Both quantitative and qualitative data are included. The qualitative the health system, and promote integrated, patient-centred care. It forms data are presented as change ideas and organization profiles, pulled the foundation of health Quality ontario 's yearly report on how ontario 's from all priority indicators.