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2015-11-12
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Quality Management Partnership: Pathology Quality Management Program U of T Pathology Update November 13, 2015 Dr. Kathy Chorneyko, Clinical Lead, Pathology, Quality Management Partnership
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OBJECTIVES
• Overview of the Quality Management Partnership
• Highlight the importance of engaging patients/caregivers
• Review of the Quality Management Model
• Update on the Early Quality Initiatives • Proposed Prioritized Standards and Indicators
• Timelines
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In March 2013, the Ministry announced a formal partnership between CCO and CPSO to develop
provincial quality management programs for colonoscopy, mammography and pathology
WHAT IS THE QUALITY MANAGEMENT PARTNERSHIP?
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Past quality and patient
safety incidents
Variation in quality of care
in hospitals and
community
Variation in processes to proactively
identify quality concerns
Ontario’s Action Plan
for Healthcare and focus on
quality
WHAT ARE THE DRIVERS?
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WHAT ARE OUR GOALS?
• Increase the quality of care and improve patient safety
• Increase the consistency in the quality of care provided across facilities
• Improve public confidence by increasing accountability and transparency
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QUALITY MANAGEMENT PROGRAM FRAMEWORK
Introduction of standards and guidelines to improve the
consistency of care provided
across facilities
Quality reporting at the
provincial, regional, facility
and provider levels
A supportive three-tiered
clinical leadership structure
Resources and opportunities
to support quality
improvement
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ALIGNING ACROSS THE SYSTEM
Quality Management Partnership
MOHLTC Initiatives
CPSO Peer & Facility
Assessments
Local Facility Structures
Health System Organizations
Existing Evidence & Standards
CCO Programs
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STATUS UPDATE: WHERE WE ARE WE NOW?
Phase 2 Report: • Contains design recommendations for colonoscopy,
mammography and pathology quality management programs (QMPs)
• Was submitted to the Ministry of Health and Long-Term Care in March 2015; positive feedback on the report was received at preliminary meetings with MOHLTC Deputy Minister
• Distributed to key stakeholders
• Will be circulated more broadly upon receipt of formal approval
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QUALITY MANAGEMENT MODEL
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PATHOLOGY QUALITY MANAGEMENT MODEL
Pathology QMP Provincial Lead
QMP Pathology Provincial Committee • Provincial Lead, QMP
• Regional leads representing academic, community and private laboratories
• Representation from CCO (i.e. PLMP), CPSO, IQMH, Path2Quality
QMP Facility Leads
Pathologists
Working groups (e.g., pediatrics)
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PROPOSED REGIONAL MODEL
! Modelled on CCO’s LHIN-based regional structure for pathology
! Private labs will have a Regional Lead who will represent the six private surgical pathology labs across the province
Regional Structure 14 Regional Leads representing hospital labs, aligned with LHIN structure
LHIN 1 LHIN 8 LHIN 2 LHIN 9 LHIN 3 LHIN 10 LHIN 4 LHIN 11 LHIN 5 / 6 LHIN 12 LHIN 7 North LHIN 13 LHIN 7 South LHIN 14
1 Regional Lead who will represent private labs Total = 15 Regional Leads
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PROVINCIAL AND REGIONAL LEAD ROLES (1/2)
Provincial Lead • Currently in final stages of recruitment Role: • Provide clinical leadership for the pathology quality
management program at the provincial level • Lead the development and implementation of a
strategy to standardize clinical quality across the province
• Chair the QMP pathology provincial committee
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PROVINCIAL AND REGIONAL LEAD ROLES (2/2)
Regional Leads • Need to be Facility Leads and will be selected
through a procurement process • Expected procurement timeline: January - May
2016 (approximately) Role: • Support facilities to implement the pathology QMP • Work with the local facilities and the QMP provincial
lead to identify opportunities for quality improvement and mechanisms to share best practices across the province and to provide a supportive network of clinical resources
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FACILITY LEADS AND PROVINCIAL QMP COMMITTEE (1/2)
Facility Leads • Will be practicing pathologists identified by the facility who are the Laboratory Director / Medical Director or identified delegate
• Expected appointment timeline: October - February 2016 (approximately)
Role: • Will provide and monitor data and oversee quality at the local level
• Are responsible to the QMP provincial and regional leads and accountable to their local facility
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FACILITY LEADS AND PROVINCIAL QMP COMMITTEE (2/2)
Pathology Provincial Committee • Will consist of QMP provincial and regional leads and other
relevant clinical leads, non-physician providers, patients/service users and subject matter experts, as required
• Expected timeline: Spring 2016 (approximately)
Role: • Provide guidance and leadership for the pathology QMP • Advise on program priorities, recommendation refinement and
future areas of expansion • Provide recommendations for improvement opportunities • Support change management and knowledge translation and
exchange across the province
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EARLY QUALITY INITIATIVES (EQIS)
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EQIs: Status Update
Baseline Pathology Survey: • Results will be used to describe the current landscape of quality in
pathology and inform the development of the Pathology QMP • Preliminary results will be reported in the fall 2015 quality report
Recommendations to improve communication and pathology diagnostic reporting on polypectomies:
• Developed preliminary list of recommendations • Engaging stakeholders for feedback on the draft recommendations
Recommendations to inform practices related to tissue exemption and tissue release:
• Legislative scan complete • Current state assessment is currently being reviewed
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PRIORITIZATION OF STANDARDS AND INDICATORS
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PRIORITIZATION OF QMP RECOMMENDATIONS
Process: ! Recommendations were prioritized using a
prioritization matrix based on Lean 6 methodology
! Leveraged preliminary results from the Baseline Survey
! Pathology Expert Advisory Working Group provided input
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PROPOSED PRIORITIZED STANDARDS (1 /3)
Foundational Elements:
Laboratories must have: • A pathology professional quality management committee. (70.51%
implemented / 11.54% in progress)
• A pathology professional quality management plan. (79.49% implemented / 8.94% in progress)
• A guideline for classification of report defects, discrepancies,
discordances and errors, and a policy for their investigation and resolution. (79.5% implemented / 14.29% in progress)
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PROPOSED PRIORITIZED STANDARDS (2 / 3)
External Review: • A policy that outlines the processes for handling requests for review
of cases by an external source, including the documentation and review of those results (83.33% implemented / 6.41% in progress)
Turnaround Times: • A policy that outlines the processes for monitoring of turnaround
times on a regular basis. (92.31% implemented / 2.56% in progress) • Collect and review data on turnaround times, for the professional
group. (Data collection: 87.18% have implemented. Data review: 73.53% review cancer and non-cancer reports; 14.71% review cancer reports only)
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PROPOSED PRIORITIZED STANDARDS (3 / 3)
Intra-operative Consultation: • A policy that outlines the processes for, and the documentation
of, the comparison of intra-operative consultation results with final diagnoses. (74.36% implemented / 10.26% in progress)
• All laboratories must collect and review data on the accuracy of
intra-operative consults and deferral rates, for the professional group. (74.36% implemented data collection for both accuracy and deferral rates / 28.17% have implemented for accuracy only)
Monitoring/ Maintenance: • Standards and best practice guidelines for internal quality
assurance must be maintained and monitored.
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PROPOSED PRIORITIZED FACILITY LEVEL INDICATORS FOR 16/17
S2Q Category
Indicator Definition
Turnaround Time Turnaround Time
• Average facility time from specimen receipt to case sign out for professional group overall for all surgical pathology cases
Intra-operative Consultation
Intra-operative Consultation Deferral Rate
• Number of deferred intra-operative consultations for the professional group/ total cases for the professional group
Intra-operative Consultation
Intra-operative Consultation Accuracy Rate
• Number of accurate intra-operative consultations for the professional group/ total cases for the professional group
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IMPLEMENTATION CONSIDERATIONS
• Prioritizing standards that have strong stakeholder support, good alignment with existing initiatives and adequate resources for execution
• Developing supports for facilities to implement prioritized standards (e.g. sharing templates and best practices)
• Focusing initially on a subset of facility indicators; provider-level reporting out of scope for now
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TIMELINE OF KEY IMPLEMENTATION ACTIVITIES
Stakeholder engagement, consultation, communications and change management
2015/16
• An inaugural report on quality (Building on Strong Foundations: Inaugural Report on Quality in Colonoscopy, Mammography and Pathology) will be released
• Begin to establish Quality Management Model clinical leadership structure (provincial, regional, and facility leads)
• Early Quality Initiatives complete
• Finalize Quality Management Model clinical leadership structure
• First release of QMP reports at the facility, regional, and provincial level
2016/17
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CONTACTS AND INFORMATION
• Dr. Kathy Chorneyko, Clinical Lead, Pathology, Quality Management Partnership [email protected]
• Annette Ellenor, Manager, Pathology, Quality Management Partnership [email protected]
• www.qmpontario.ca