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We are an independent policy think tank, intent on changing the health-care debate, health-care practice and the health-care experience in Ontario.
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NEWS ARCHIVES2010 news
Moving on our strategic plan step by step: Step #1, scan Ontario patient & caregiver surveys to listen and learn "To listen well is as powerful a means of influence as to talk well, and is as essential to all true conversation." (Chinese proverb) The Change Foundation's 2010-2013 strategic plan, Hearing the stories, changing the story, is focused on advancing a patient-centred health-care system in Ontario. We'll begin by listening to - and learning from - the lived experiences of individuals and caregivers moving around Ontario's health system over time. But first, we need to know what's known. So we produced a review of patient and provider surveys of individual and caregiver experiences with the health-care system. Read the Survey Review, prepared by Brenda Tipper for The Change Foundation. It looks at 24 surveys of patient or caregiver experiences with the health- care system, either based in Ontario, or if national, with a presence in Ontario. What did we learn from our look? The short answer: existing surveys provide only a partial picture. They tend to focus on the patient experience within an organization, but questions about how individuals experience continuity of care, navigation across different providers, and transitions between organizations are a relatively minor focus - if queried at all. As the review concludes: "None of the existing surveys or projects included in this review really examines directly, or in any comprehensive or systematic way, the experience of individuals and caregivers as they move in, out of, and across Ontario's health-care system over time and as their health changes."The Change Foundation's quest continues. Follow our progress by reading future Step by Step updates. Step 2: Gleaning from those who've gone before: The Change Foundation examines survey findings in companion piece on patient/caregiver experiences in Ontario To delve deeper into the Survey Review, The Change Foundation summarized the findings of a dozen patient/caregiver surveys and in a companion piece offers the following observations:
From the 24 surveys and projects examined in the review, we selected 12 with publicly accessible findings from which to probe for the following elements of the patient experience:
What's the next step? With the input of patients and caregivers, we will provide a more comprehensive picture of their experiences navigating the system. Stay tuned for more about our stepped-up activities in this early phase as we gather information, plan our engagement, and roll out future collaborative work in 2011 - to help change this province's debate, practice, and experience - to help rethink and redesign our system with patients and caregivers top of mind.
Social media is redefining how the world interacts and The Change Foundation wants to join in the conversation by integrating the right mix of new media tools on our website. If the topic compels, do you, would you - tweet, friend, read blogs, chat, or comment? Please take five minutes to fill in our Fall 2010 website survey (12 questions) to help guide and inform this overdue upgrade. Your needs and preferences will help us strategically integrate the connective and collaborative power of social media to potentially tap into real health-care stories to inform our future work to improve the experience of caregivers and individuals as they move in, out of, and across our health system. These real-time, open access new channels will also help us better listen, respond and collaborate with you - our audience. Of course, we also want and need feedback on key ongoing design and functional elements on our current site. What should we keep, change or lose? Is information easy to find and clear? What kind of information is most useful to you professionally - chart-packs, reports, commentaries? To add incentive, we'll award two Apple IPod Shuffles by random draw to lucky survey respondents. The deadline to reply is Friday December 10. Spare us a minute, affect Change! Take our Fall 2010 website survey.
"We have the system we've incented... if we want something different we will have to incent it differently." As Ontario experiments with new patient-based payment methods under the Excellent Care for All Act, The Change Foundation offers analysis, examples, and advice on using funding models to improve the quality and experience of patient care. The report, Tools for Change: Funding Incentives and Levers for Integrating patient care in Ontario (November, 2010), flows from a symposium The Change Foundation organized last spring with support from the Ministry of Health and Long-Term Care. The paper includes Canadian examples of funding/incentive models, a summary and lessons from the symposium and the U.S./U.K. case studies, as well as key findings from the literature. Insights from inside & outside Canada
And if you haven't already listened to the video podcast of Change Foundation CEO Cathy Fooks in conversation with U.S. Governor Howard Dean, who was the keynote speaker at the spring symposium, have a look and listen: Dean says the U.S. system must move beyond current laudable insurance reform to focus on deeper issues of quality and integration. Read the full report, and related resources. See pictures from the symposium.
Both jurisdictions will be challenged to reform their respective health systems to ensure sustainability, as well as improving quality and access - to do things differently to be able to do better with less. England's National Health Service (NHS) is in the middle of a major shakedown with radical reforms proposed by the Cameron-Clegg Coalition government as outlined last July in a White Paper: Equity and excellence: Liberating the NHS. Chris Ham, Chief Executive of U.K.'s leading health policy think tank, The King's Fund, calls the proposed changes "the most radical reforms since the inception of the NHS." The Change Foundation continues to keep a keen eye on this health-care landscape (see item below on the Foundation's paper updating our audiences on the reforms) with a long history of regionalization to glean learning for Ontario which faces similar challenges and imperatives - how to improve quality, shift our sights to creating a patient-centred system, and do so with constrained resources. In Ontario, we might ask: How to make the most of the opportunities that could emerge under Ontario's Excellent Care for All Act? Perfect timing for our second Hot Talks on Health featuring the first Chair of U.K.'s Care Quality Commission (2008-2010), the Rt. Hon. Baroness of Old Scone Barbara Young. The event was held October 28th in partnership with the University of Toronto's School of Public Policy and Governance. The recently appointed Chief Executive of Diabetes U.K., a wise and witty woman with decades of health-care leadership under her belt, brought life and illumination to these reforms. The U.K. government's massive program review announcement a week earlier made the event even more timely. Addressing a packed and absorbed house of public policy thinkers and doers, she outlined the political climate which has led to the proposed seismic health and social care reforms - and the financial climate in which they are taking place. Running through the key elements of the reforms - focusing in particular on the impact on quality and integration and the contentious shift to GP commissioning - she queried whether the reforms could be implemented on the scale and pace with which they have been proposed without a major cultural shift. She said the pace and scope of the reforms should give one pause - can it be done? - and warned that although the NHS "does change well", the energy directed towards continual restructuring can inhibit the permanent progress on quality. She sketched several scenarios for the future: rebranding of the old system with new buzz words; a meltdown; or working with what emerges to deliver an innovative, integrated system for the benefit of the public and service users. For now, you can listen to Baroness Young's engaging and richly informed speech, aptly titled Health and Social Care Reform in a Cold Climate (in two audio parts). Stay tuned for a complete video podcast of this candid and insightful talk and follow-up discussion by a panel of Ontario experts: Ross Baker, Carolyn Baker, Ben Chan. Take a look at event's agenda and pictures.
To coincide with Baroness Young's Hot Talk (above), The Foundation released an Update to our May 2009 international case study on the NHS, Recent National Health Service (NHS) Reform Proposals In England, An Update to Integrated Health Care in England: Lessons for Ontario (The Change Foundation, May 2009),November 2010. The brief analyzes the latest chapter in the NHS journey, assessing main U.K. change proposals and how they apply to Ontario's health-care system. The report also links to key reaction to reforms by The Kings Fund and The Nuffield Trust for Research and other respected U.K. policy voices. The Foundation's Update outlines major proposed White Paper changes and how they apply to Ontario. Read the short Update and learn more about the U.K.'s health-care reforms.
"On balance, most of us conclude that this is the best set of health reforms possible in a country that is very deeply divided in its belief in government... We struggle with this as a people." The U.S. has taken a significant "step forward" with recent insurance reforms started under the Affordable Care Act said Susan Dentzer, Editor-In-Chief of Health Affairs, but real change embracing Canadian-style universal coverage and other fundamental elements of high performing systems will take lots more: time, ongoing commitment and deeper consensus. The witty journalist captivated and enlightened her audience as The Change Foundation launched its first Hot Talks on Health last May, in partnership with The Canadian Club of Toronto. The award-winning on-air analyst said "history had called" but joked that Winston Churchill was still right: "You can always count on Americans to do the right thing after they've tried everything else." She outlined how the promising new Act extends coverage to many more Americans by 2019, forecasted to blanket 65 million from the current 23 million. Dentzer offered a brilliant yet breezy analysis of the policy and politics behind the U.S. reforms and the opportunities and challenges ahead. She warned that "the politics is not over," rightly forecasting that Republicans would take back seats from Democrats in November mid-term elections, thereby potentially affecting the depth and pace of health-care reform. See the first video clip of her thought-provoking talk. President Obama's eight key health-care objectives: What lies ahead? Accountable Care Organizations "If this potential is seized, we'll have a very different looking health-care system in a decade," said Dentzer. She gave examples of many "best actor" hospitals and health systems already in queue for ACO involvement including Geisinger Health. (See clips on "Implemageddon" and the challenges ahead). Audience Q & A See all video clips of this Hot Talk and pictures. Hear one example of creating an integrated health system close to home by tuning into a new wide-ranging feature interview (part of our Integration Incubator series) with Kevin Smith, President and CEO of the newly integrated St. Joseph's Health System and Foundation board member. St. Joseph's offers a continuum of services spanning acute care, long-term care, community care, rehabilitation, hospice, and mental health. Smith was interviewed at our Tools for Change: Funding Incentives and Levers for Integrating patient care in Ontario Symposium last spring (2010). Smith's deep understanding of complex issues and his senior and wide-ranging experience in Ontario health care are in evidence as he talks about how to use financial incentives to propel better integration. He also comments more widely on successes and challenges to date leading change across two LHIN boundaries in Hamilton, Kitchener and Brantford, serving three million residents. View the video clips of his interview.
"We've found that doing shift handovers at the bedside reduces anxiety for patients, when they're able to meet the incoming and outgoing nurses at the same time." The Quality Congress that wrapped up the year-long pilot phase of Releasing Time to Care™ heard these and other examples of positive change from the staff-led, data-driven improvement program. CHQI has launched Wave 2 with made-in-Ontario training materials, including a Reflections video that demonstrates how the program unleashes creative solutions to inefficiencies and interruptions that detract from quality care. Check out CHQI's fall 2010 e-news, Quality Pulse for more news and resources.
Patients, advocates and health-care leaders tell us in a wrap-up video at The Change Foundation's recent Meeting of the Minds: Rethinking Health Services with Patients Top of Mind. Answers varied, but all agreed that we won't create a patient-centred system without listening to, and partnering with, the people it should serve. Listen to a compilation of responses Playback video from an eclectic mix of patients and advocates, LHIN CEOs, policy experts, practitioners, health-care association leaders and more. Or pick and choose (see below) from the views that might intrigue you. (And give us your take on patient-centred care at TalktoUs@changefoundation.com - and we'll report it back in our next e-news) From Ontario, long-time SickKid's patient and advocate Kariym Joachim, Co-chair of Sick Kids' Family-Centred Care Advisory Council, thought we're doing some things right already in Ontario to include patients/families in humanizing the care environment for kids; family doctor and Canadian Doctors for Medicare President Danielle Martin said patients need to see physicians as coaches and take charge of their own care; Nick Kates, Director of Improvement from Hamilton's Family Health Team & QIIP (Quality Improvement and Innovation Partnership) Ontario Lead, said following the patient journey firsthand to gather insight is key to providing safe, convenient care. Mississauga LHIN CEO Bill MacLeod said the system needs a fundamental power shift from accommodating providers to addressing the needs and preferences of patients and their families and caregivers. Advice from the U.S. and across the Atlantic? U.K. presenter and policy advisor Laura Bunt, from the National Endowment for Science Technology and the Arts, said patient-centred care means shared decision-making and responsibility and must position patients as meaningful partners in sustained redesign efforts (see Bunt's longer interview and presentation). And from the U.S., PlaneTree President Susan Frampton applauded Ontario's planned province-wide patient survey as a good first step to guide change towards a more responsive system but also emphasized the key role of funding models and incentives to change the behaviour of health-care providers. Other insights:
Join us October 28th for our second Hot Talks on Health featuring the first Chair of the U.K.'s CareQuality Commission (2008-2010), the Rt. Hon. Baroness of Old Scone Barbara Young. In partnership with University of Toronto's School of Public Policy, The Change Foundation is offering an opportunity to get the goods on what the U.K.'s radical health reforms mean for quality and patient care. Known as a powerful, straight-talking speaker and inspirational leader, Baroness Young will help decipher the government's latest restructuring proposals, with an eye to their potential impact on quality and patient-centred health systems. You will have a chance to question Baroness Young and engage with a panel of Ontario health leaders who will pick up on issues relevant to Ontario's emerging health-care quality agenda. The Change Foundation launched Hot Talks on Health last May with a compelling address about U.S. health reforms by award-winning journalist-turned Health Affairs editor-in-chief Susan Dentzer. (Stay tuned for video and other resources from our Hot Talks on Health series.)
Fee-for-service and pay-for-performance models can drive inflationary health-care costs and do nothing to advance quality, warned U.S. Governor Howard Dean at a symposium hosted April 26 by The Change Foundation, in partnership with the Ministry of Health and Long-Term Care. The invitational event, Tools for Change: Funding Levers & Incentives for Integrating Patient Care in Ontario, engaged about 100 health-care stewards and stakeholders in tackling a central question: how do we create a system of funding and incentives that best enables providers to achieve seamless, coordinated care for patients across all settings? Watch a video podcast with the dynamic Dean and Foundation CEO Cathy Fooks. The Q & A covers the politics behind the U.S. reforms, Dean's hopes for the future, and his country's best examples of integrated "one-stop shopping" health systems such as Kaiser Permanente, Geisinger Health Systems, and Federally-Qualified Health Centres. Dean characterized changes to U.S. health-insurance legislation as "baby steps" that extend coverage but leave intact a deeply flawed system. The U.S. leader praised Canada's universal single-payer system but said both countries need to improve quality and "vertical integration" by building stronger connections and accountability between primary care, acute care, specialty care and community care. The timely and talkative forum was held in the wake of Ontario's decision to reform funding and pay-for-performance models through Bill 46. It provided examples from inside and outside Ontario of attempts to incent health-care improvement through new funding models. Learn about Alberta Health Service's experiment with activity-based funding: read a presentation by Mike Conroy, EVP Corporate Services. Look at what's on offer in Ontario: Bill Casey, ED Primary Health Services, talks about the Peterborough Family Health Team's efforts to manage at-risk vascular patients. Bonnie Adamson, North York Hospital CEO, and Cathy Szabo, Central CCAC CEO, share the story of how that hospital and CCAC collaborated to tackle the issues around patients being in the wrong place at the wrong time. Brian Golden, Chair in Health Sector Strategy and Professor Rotman School of Strategic Management asserted that we can create value in health care by realigning care and incentives and pointed to the potential of the Integrated Client Care Project. Joy Galloway (video) ED of Timmins Family Health Team describes how incentives paid to FHT doctors to encourage particular types of preventive care are helping patients tackle chronic disease. Other commentators providing a range of perspectives: Alan Iskiw, Senior Director, Performance, Contract & Allocations, Hamilton Niagara Haldimand Brant LHIN; Camille Orridge, CEO Toronto CCAC, and Lou Reidel, Director Policy & Research, OHA. Also stay tuned for a future video interview from this forum with speaker Kevin Smith, CEO, St. Joseph's Health System.Read case studies informing the forum: Incentives to improve primary care: Critiquing the Quality and Outcome Framework in England and Funding Incentives for Integrating Patient Care, A U.S. case study: Federally-Qualified Health Centers (FQHCs). See photos from the event and an advance Foundation-hosted dinner attended by Governor Dean and Health Minister Deb Matthews. See all resources and stay tuned for a Symposium summary report this fall.
- Forum fitting launch pad for new strategic plan that seeks to change the debate, change the practice, change the experience - "Those of us who have worked to advance patient-centred care tend to forget that few people outside health care have ever heard of it. ... They (patients) need to know where and how they can partner with professionals to achieve the best possible outcome. They need to feel included and informed and respected and empowered." To create a patient-centred system and improve people's health-care experiences, we need new accountabilities, alignments, and attitudes to build a true partnership with the people who use health care to redesign services around their ongoing needs and preferences by listening and learning from their lived stories - both positive and painful. Those themes - among others - emerged during The Change Foundation's 3rd annual Meeting of the Minds: Rethinking Health Services with Patients Top of Mind, June 22 & 23. An eclectic line-up of compelling and substantive participants and speakers from across Canada , the U.K. and the U.S. challenged - and were challenged by - a group of national and provincial health-care and association leaders, patient and caregiver advocates, community leaders, health-care practitioners, LHIN CEOs, and representatives from the education and retail sectors. As part of the program, they were asked to clarify what a patient-centred health-care system means, and to identify the first thing we need to do to improve the patient experience in Ontario. See what they came up with: Playback video from the day. The forum also served as a fitting launch pad for Change Foundation Chair Scott Dudgeon to release The Change Foundation's 2010-2013 strategic plan, Hearing the stories, Changing the story.Read his remarks. "The Change Foundation is narrowing its focus to improving people's health-care experiences as they move in and out of and across the system because a high-performing health system understands, measures and responds to the patient experience. That should be front and centre in any health-care reform - not just symbolically, but substantively. This is no frivolous focus; it aligns with - and we hope advances - part of the province's public policy agenda," said Dudgeon. In framing the discussion for the meeting and the policy rationale for the event and the Foundation's goal, CEO Cathy Fooks (remarks) asked participants how health care (and the metrics) in Ontario would change if the system were truly conceived and delivered with patients and their caregivers at the core. Appropriately enough, the Meeting's first presenters were Patrick Conlon (remarks), writer and patient/caregiver advocate, and Kevin Leonard (presentation), patient/researcher. Drawing on their own experience, research and reflections, they injected an urgent and personal plea for patient-centred care and a system that supports it. Read the full strategic plan and the accompanying environmental scan. Give us your views on our plan. What's on offer in the U.S. & U.K.? Participants heard directly how integrating the voices and views of patents can make a difference through longtime SickKids' patient and later Children's Council and Family-Centred Care Advisory Council member Kariym Joachim (video) who was involved from age five to eighteen to help humanize his hospital environment. His co-chair Barbara Muskat spoke of the importance of formally integrating and supporting patients to improve care. News & views from Canada? Lessons from other sectors? See all 2010 Meeting of the Minds resources. Hear our research advisor Steven Lewis's insightful closing remarks. Meeting of the Minds 2009 report released: See photos from Meeting of the Minds 2010 and 2009.
The Centre for Addiction and Mental Health (CAMH) is the second Ontario health-care organization to join a pioneering inquiry into a promising frontier - Using on-line patient dialogue to drive health-care improvement.The project a partnership between The Change Foundation and the Health Strategy Innovation Cell, started last fall when Providence Healthcare in Toronto came on board. Both Providence and CAMH, have strong commitments to quality improvement (QI). The project aims to develop and test emerging best practice guidelines for healthcare organizations on the use of open-access social media such as Twitter, Facebook and blogs to improve patient care. It is guided by the advice of an 11-member ginger council with social media and health-care expertise. Since our last Top of Mind update, The Innovation Cell project team has been immersed in CAMH and Providence's worlds, attending QI forums and leading on-site workshops to listen to and learn from organizational leaders about workplace culture and QI goals and projects. With that understanding, the team will propose how to best build and buoy strategic Web 2.0 synergies. At the same time, the team has been monitoring online health-care discussions related to the two organizations and their QI goals best complemented by social media tools. "We're curious about what we'll learn as a field partner in this unique project. Will we hear different voices and views via social media versus traditional approaches, and can we use what we glean to improve our care on a continuous and proactive basis? And how do we begin? These are some of the questions we hope to answer through this unique project," says CAMH Vice-President of Communications and Community Engagement Susan Pigott. An interim report will be circulated this fall, encapsulating learning to date on using social media for QI and laying the groundwork for future work. This first report will inform on leading practices, key challenges, opportunities and privacy considerations and summarize results of a series of environmental scans. The scans include: a snapshot of who's using social media and how they're using it within Canadian healthcare; top lessons on reputation management as patients share real-time experiences (good and bad) about care received; and emerging privacy issues related to this fast-changing medium. The project will also produce two case studies drawn from the field partners' experience, offering first-hand lessons for Ontario health-care organizations grappling with similar issues while trying to integrate social media within their own QI efforts. This collaborative venture will also produce an ‘e-toolkit' of best practices to help health-care organizations determine if these tools are a good fit for their QI goals. This resource will be a practical guide to help them consider integrating what they are hearing and learning from on-line conversations into their plans to map meaningful patient-centred change within their settings - all the while building in necessary accountabilities as they adopt and adapt to Web 2.0 ways. In the meantime, Neil Seeman, Director and Primary Investigator of the Health Strategy Innovation Cell, recommends the following hot summer social media reads to ramp up your savoir faire in the area.
Read more about the opportunities and challenges of using social media to improve health care.
Improvement teams with the multi-partner Integrated Client Care Project have swung into action; the project helps to further The Change Foundation's priority on improving home and community care. CHQI has taken each of four interdisciplinary teams through a three-day exercise of analyzing and redesigning their care processes with an eye to more integrated care and better outcomes for clients. Supported by a radically new funding scheme in which home and community care providers are paid for a bundle of services tailored to clients over time, Community Care Access Centres and home-care providers in Windsor, Brampton, Ottawa and Sudbury are the first out of the gate to implement this approach. Designing and testing changes to how wound care is provided for people with diabetic foot ulcers and venous leg ulcers over the next 18 months, they are paving the way to province-wide permanent change in how health care is delivered in Ontario. "This project is a perfect fit with CHQI's expertise in improvement science and change management," said Paula Blackstien-Hirsch, Executive Director of CHQI. "CHQI's role is to help the teams gain the skills and knowledge to do the challenging improvement work - to integrate fragmented services, remove redundancies, ensure best practice, and effectively engage clients and caregivers in the change process." Read more about Integrated Client Care and other initiatives in the latest issue of The Quality Pulse, CHQI's e-newsletter
The Change Foundation today officially released its 2010-2013 strategic plan, Hearing the stories, changing the story, and announced its new goal - to improve the experience of individuals and caregivers as they move in, out of, and across the health-care system over time as their health changes. Read the Strategic Plan page - which includes the full strategic plan or the summary version, and the accompanying environmental scan. Read the Top of Mind Alert - The Change Foundation releases new Strategic Plan.
Vivek Goel, president and chief executive officer of the Ontario Agency for Health Protection and Promotion, and Ron Sapsford, former Ontario deputy minister of Health and Long-Term Care and senior health-care executive, bring even greater bench strength to The Change Foundation's Board of Directors. The notable names joined the Board June 10 during interesting times - just as The Change Foundation approved its 2010-2013 strategic plan which tilts the Foundation's focus onto improving the experience of individuals and caregivers move in, out of, and across Ontario's health-care system. (see item above) "We welcome the unique abilities and experience of these two proven health-care leaders as the Board begins to activate its new plan to change health-care's debate, practice - and experience. The new members' high-level insights and understanding of the barriers and possible breakthroughs to improve health-care experiences will help steer us strategically towards our goal," said The Change Foundation's CEO Cathy Fooks. These two new members help round out the Board's knowledge and expertise in public health, clinical care, government and public policy. One vacancy remains on our 12-member board. Goel and Sapsford replace former board members Dr. David Walker, former Queens University Dean, and Glenda Yeates, Deputy Minister of Health Canada. See who else is on board.
Highlights: Keynote by former U.S. Governor Howard Dean, Alberta's foray into funding reform, examples of new approaches in Ontario See agenda, speaker bios and participant list. "Vertical integration" or better connections and accountability between primary care, acute care, and community care is a big, common problem for both Canada and the U.S., said former U.S. Governor Howard Dean during a symposium, Tools for Change: Funding Levers & Incentives for Integrating Patient Care in Ontario, hosted April 26th by The Change Foundation, in partnership with the Ministry of Health and Long-Term Care. Dean also told an engaged audience of about 100 Ontario health-care leaders that fee-for-service-models which pay doctors for each task they perform drive inflationary health system costs and do nothing to advance quality and prevention. Dean praised Canada's universal single-payer system and said Americans have much to learn from it despite its problems. The dynamic U.S. leader characterized recent changes to U.S. health-insurance legislation as "baby steps" that extend coverage but leave a flawed system intact. He hoped, however, that it would lead to real reform for Americans in the future. The timely and talkative forum, held in the wake of the government's announcement that it intends to pursue patient-based funding and pay-for-performance models, pulled from key health-care constituencies from across Ontario's system and the country. The central question: 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? To answer that question, we need to ask others: Does the way health-care providers are paid motivate change? Can incentives be aligned to support integrated care and improved patient experience? Is activity-based funding, patient-based funding, pay-for-performance, blended models, or bundled reimbursement the way to go? What's worked well where, and why? Speakers from Ontario and beyond included: See all resources including a U.K. case study, Incentives to improve primary care: Critiquing the Quality and Outcome Framework in England by Dr. D.S. Woodhead and a U.S. case study, Federally Qualified Health Centers by Joni Steinman. Stay tuned for a report from the event and a podcast interview with Governor Howard Dean and other voices from the day in our May Top of Mind e-newsletter. Subscribe today.
The Change Foundation, in partnership with The Canadian Club of Toronto, launches a new speakers' series, Hot Talks on Health, on Friday, May 28th with a leading and lively American health policy mind to deconstruct the health-care changes underway in the United States-and the takeaways for Canada. Susan Dentzer is the Editor-In-Chief of Health Affairs, the nation's top journal of health policy and an award-winning on-air analyst on health issues with The NewsHour with Jim Lehrer on the Public Broadcasting System (PBS). Read her bio. Order your tickets here. Learn from one in the know what to make of the new health-care legislation in the U.S. - sea change or snail's pace? What kind of role did providers, insurers, politicians, the public - and the President - play in influencing the shape of the final bill. Amid all the political debate, backroom drama and negotiated details, what has been achieved and what opportunities have yet to be realized? What will the measures of success be? What does it mean for access, quality, equity, cost? What's the next step? And are there lessons for Canada? In the fall, The Change Foundation will be presenting a speaker from the U.K. who will cast light on what the results of the May 2010 election mean for future of health reform in the U.K..
Research conducted by Boston Consulting Group for The Change Foundation and the Community Provider Associations Committee (CPAC) quantifies for the first time the economic value of home and community care services for a discrete population in Ontario and provides an extrapolated figure reflecting the potential province-wide savings accrued from avoiding higher-cost institutional care. The Valuing Home and Community Care project, funded by The Change Foundation and some CPAC members including the Ontario Association of Community Care Access Centres, was focused on a subset of the Home and Community Care client base of the Hamilton Niagara Haldimand Brant CCAC - a representative sample of the frail elderly 75 years and older who account for approximately 25% of the CCAC's clients. By looking at that particular group's use of home and community care, assisted living/supportive housing services, primary care, long-term care, and hospitals and calculating costs avoided and costs incurred - including the impact on informal caregiver productivity -, the analysts arrived at a potential cost savings of $13 million in this region alone from the appropriate use of home and community services, with projections of potential province-wide saving of $150 million per year. Read key findings and methodology. The report includes patient and caregiver stories with an analysis of their situations, as well as synopsis of interviews with health care professionals. One snapshot story: Annette received home and community care, allowing her to live at home four years longer than she would have without care; subsequent Assisted Living services delayed her move to a long-term care home for two years. Better quality of life in the appropriate place and less expensive care. Read client/caregiver stories/analysis and synopsis of health provider interviews. "This research underscores the need to find better fits between the level and location of care provided for Ontarians and their particular health, social and quality-of-life requirements," said Change Foundation CEO Cathy Fooks.
The Change Foundation's quality improvement asset and ally - the Centre for Healthcare Quality Improvement (CHQI) - will contribute its formidable QI training know-how to help strengthen home and community care in Ontario as a key on-site mentor in the provincial Integrated Client Care Project. CHQI has teamed up with the Ministry of Health and Long-Term Care, the Ontario Association of Community Care Access Centres (OACCAC), and the Collaborative for Health Sector Strategy at the Rotman School of Management, University of Toronto to better integrate wound care services for people with diabetic foot ulcers and venous leg ulcers at four early implementation sites. To help CCACs and their service providers, CHQI will offer coaching and expertise in project management, improvement science, and change leadership and management. Later QI efforts will centre on the coordination of palliative care, chronic disease management, care for frail elderly and children with complex medical conditions. After site visits completed this spring, CHQI will facilitate "value-stream mapping" to help local interdisciplinary Improvement Teams analyze current processes, identify waste, and prioritize opportunities for redesigning care to incorporate the critical elements to be included in future care delivery for wound care in the community. The project was launched April 13, 14 and 15 for close to 100 senior leaders and improvement team members from these early implementation sites. The teams will design, test, and implement process and practice changes based on six key elements of the Integrated Client Care service delivery model appropriate for these sites and with wider potential learning. Learn more about CHQI's role in the project. The project is a key component of MOHLTC's "Strengthening Home Care Services in Ontario" strategy.
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).
2009 news
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.
2008 news 
December 17, 2008. Read our latest enews - Top of Mind - December 2008
A collaborative project (The Change Foundation and the Ontario Association of Community Care Access Centres) studying the complex patient journey from hospital to home or to long-term care aims to improve this experience by listening and learning directly from patients. Phase two of "Having Their Say and Choosing Their Way: helping patients and caregivers move from hospital to home" is underway at the Toronto Western Hospital and the Toronto Central CCAC where consultants are mapping both journeys and have provided an interim report. Two groups of eight-to-ten elderly patients transitioning from hospital to subsequent care settings are being interviewed to better understand what services and information they value during these moves. These in-depth, one-to-one home interviews conducted with supportive family (or substitute decision makers) present capture all the decisions and arrangements with different service providers. Many of these patients face linguistic challenges, adding another layer of difficulty in finding their way through the system. When asked where they'd start when looking for help at home, a typical interviewee having recent experience receiving home care answered: "I don't know. I'd have to call some agency, you know, some agency." "Many health care projects are geared to studying patient 'flow' through various parts of our system, but our unique focus here is to find practical ways to improve the actual experience as they move through these passages. Do they have all the supports and information they need to make the best care decisions?" said Toronto Central CCAC Senior Director of Client Services, Stacey Daub. The Change Foundation and OACCAC will receive a final report in the spring of 2009 that encompasses and compares findings from the two phases. The first phase took place at Quinte Health Care's Trenton Memorial with the South East CCAC. Phase 1 findings reflected process complexity (160 transition steps) and patient confusion. The final report will be shared widely, including with senior directors at CCACs, to promote the development of leading practices for proactive community placement and support.
Thanks for filling us in with your helpful — and happy — responses to our first website survey. It's been just over a year since we launched our new website, and we're pleased to learn that almost all of you (89%) use our work in your work: you cite our resources in your reports, you scan our materials to learn more about Ontario health care and you turn to us for ideas to help plan or propose health care projects. Over 80% of you rated our content and design as good or excellent. We will work hard over the coming year to heed your suggestions, such as introducing alerts for new content and producing more of our well-used Facing the Facts fact sheets. You can tell us how we've done in our next annual survey. Congratulations to our three website survey prize winners, chosen by random draw. (Prizes: IPod Shuffles and an individual subscription to Longwoods Publishing, donated by the Publisher). And the winners are:
Continue to build your brain amid the many distractions of the merry season by taking our second acrostic challenge. Test your tête with our December 2008 puzzle which, once answered, will reveal a quote connected to the why and how of community engagement in health care. To get started, download the acrostic software and fill out the puzzle. (See completed sample from last time here) See the completed December 2008 puzzle (posted on January 12).
The Change Foundation has created the first in a series of Change Chart Packs— downloadable data from various sources about a range of health care issues in Ontario, from funding and care integration to service utilization and informal caregiving. You can easily insert your choice of Change Chart Packs into any powerpoint presentation or report. Watch in the coming months for more Change Chart Packs, based on data generated from The Change Foundation's own research and analysis. To access Change Chart Packs, click here.
Change Foundation CEO Cathy Fooks talks to the HNHB Palliative Care Network's 6th Annual Innovations in Palliative Care Fostering Uninterrupted Care...Sharing Vital Information conference about the Foundation's Who is the Puzzle maker? report. One of the key objectives of the conference was to develop a broader understanding of systems and how the components fit together to impact the hospice palliative care that people receive.
The Change Foundation dedicated its 1st Meeting of the Minds to examining the lessons learned from more than a decade of regionalized health care across the country- lessons that could be instructive for Ontario during its early days of devolved health-care decision making under Local Health Integration Networks (LHINs). To elaborate on those lessons, The Change Foundation lined up some key, clever people who led and lived through health-care regionalization across Canada to frankly assess what went right and wrong, and to deliberate with Ontario leaders about what might improve prospects for success as the province's health integration agenda evolves. Read the highlights.
Thanks for filling out our website survey - 3 random respondants have won an individual Longwoods publication subscription and two IPod Shuffles. We will review the survey results and use them to improve our website.
There has been an enormous amount of work done to get the LHINs up and running and immersed in integrating health services. Amid the flurry, a union has issued (and lost) a legal challenge to a LHIN decision, some accountability agreements have not been reached, and supervisors have headed into hospitals to help them meet new mandated requirements. Given that much of the LHIN legislation is untested, it's not surprising that questions – and confusion – about rules, authority and ambiguities abound. To help understand those rules, The Change Foundation commissioned Health Law & Policy firm Osborne Margo to produce a plain-language guide to the key elements of the legislation governing the LHINs, read Structure, Powers and Accountability of Local Health Integration Networks.
The second and final phase of The Change Foundation's joint quality improvement project with OACCAC – Having Their Say and Choosing Their Way: helping patients & caregivers move from hospital to home - continues this fall in Toronto in partnership with the Toronto Central CCAC and Toronto Western Hospital. The report from phase 1 (South East CCAC and Trenton Memorial Hospital) helped to inform a recent discussion of CCAC senior directors on best practices in the area. Read the report from phase 1, and stay tuned for phase 2 results by the end of the year. Read a Hiroc news article about phase 2. October 14th, 2008 Pollster/ pundit Allan Gregg and Globe and Mail health columnist Andre Picard give us their takes – and their intelligence -- on that question, and much more in two Top of Mind Q&A interviews.
Welcome to The Change Foundation Acrostic Puzzle (#1). To get started, download the acrostic software, follow clues and fill out the puzzle. An underlying health-care quote or title will reveal itself. The answers are found on the completed version here, but don't look until you're done. Good luck! (Please note: the software requires Windows, but if you're a Mac user we'd be happy to fax you a copy of the puzzle) Puzzle #1 - Clue: this quote comes from a former Canadian health-care commissioner who attended our May 2008 Meeting of the Minds exchange. The first completed entry will win a $45 gift certificate from Chapters books.
Read the powerpoint and the report. See the video.
Read more about this event, or tour our photo gallery.
The Change Foundation's strategic plan and its 2006-2007 corporate annual report - both designed by hm&e design communications - have both received a prestigious national design award, including a special nod as a "Judges Choice" for our annual report. The awards, called the NUARs, are sponsored by Unisource Canada and recognize excellence in the design and production of annual reports and corporate brochures. The winning Annual Reports and Corporate Brochures will be part of a travelling exhibit to be showcased in ten Canadian cities, starting in October.
CEO Cathy Fooks is pleased to announce the establishment of the Centre for Healthcare Quality Improvement (CHQI) at The Change Foundation, effective July 1, 2008. Formerly known as the Ontario Health Performance Initiative (OHPI) of the Ministry of Health and Long-term Care, CHQI is now part of The Change Foundation and will operate at arms-length from the provincial government. The initiative was established in 2006 to accelerate quality improvement in Ontario to improve system-level outcomes in areas of provincial strategic priority. Learn more here or view a Q&A video with CHQI Executive Director Paula Blackstien-Hirsch.
Patients and their caregivers in the South East want and need timelier, clearer information with proactive community placement planning to find the best, next care when moving from hospital to home. These are some of the key findings from phase 1 of a quality improvement project called Having their Say & Choosing their Way: helping patients and caregivers move from hospital to home. The project is funded by The Change Foundation, in partnership with the Ontario Association of Community Care Access Centres (OACCAC). The Toronto Central CCAC and a Toronto Central LHIN hospital will be involved in the second phase of the project; details will be announced in the fall. Read the phase 1 report, news release and summary of findings.
Cathy Fooks shares her thoughts on the Foundation's mandate, mission and new report (see below) supporting a "smooth journey" for Ontario patients with IQP's Graham Murray.
Ontarians want and need clearer two-way communication among all the parts and players in our health system and better coordination of services, according to a new report released today by The Change Foundation. Who is the Puzzle maker? Patient/Caregiver Perspectives on Navigating Health Services in Ontario is The Change Foundation's first health integration report.
2007 news October 22, 2007
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