Welcome to Cancer Care Ontario September 11, 2013 Garth
Matheson CAPCA - COO Roundtable
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We do more than Cancer now Performance Management and
Management Cycle Standards and Guidelines Public Reporting and
Transparency IM/IT Health System Policy Expertise Clinical
Engagement and Alignment Regional Partnerships Cancer As mandated
by the Cancer Act; Ontario Cancer Plan III Access to Care Building
on Ontarios Wait Time Strategy Chronic Kidney Disease Ontario Renal
Network launched June 2009; Driving performance and quality Core
Competencies 2
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Our new Mission Together, we will improve the performance of
our health systems by driving quality, accountability, innovation,
and value Our new Vision Working together to create the best health
systems in the world Vision and Mission 3
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New Corporate-wide Areas of Focus Patient-Centred Care
Prevention of Chronic Disease Integrated CareValue for Money
Knowledge Sharing & Support 4
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Organizational Structure Audit and Finance Committee Vice
President, CIO Vice President, Ontario Renal Network Vice
President, Clinical Programs and Quality Initiatives Vice
President, Planning and Regional Programs Vice President, Planning
and Regional Programs Vice President, Chief Financial Officer Vice
President, Prevention and Cancer Control Vice President,
Communications Board of Directors President and CEO Vice President,
Corporate Services, General Counsel and Chief Privacy Officer 5 14
Regional Vice Presidents
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14 Local Health Integration Networks = 14 Regional Cancer
Programs 6 Population = 13.5M ~ 65,000 new cases ~ 25,000 deaths 17
facilities delivering radiation (103 Linacs) 77 facilities
delivering chemo
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Cancer Survival in Ontario 7
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The System Strategic Plan S I X STRATEGIC PRIORITIES The
Ontario Cancer Plan III (2011 2015) 1 Develop and implement a
focused approach to cancer risk reduction 2 Implement integrated
cancer screening 3 Continue to improve patient outcomes through
accessible, safe, high quality care 4 Continue to asses and improve
the patient experience 5 Develop and Implement innovative models of
care delivery 6 Expand our efforts in personalized medicine
www.cancercare.on.ca 8 8
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CCO does not operate facilities or deliver care Principle
advisor to govt. Plan the system Oversight of the system Pay for
volume / purchase service ($1.6B) Establish quality and access
targets Monitor and drive performance 9
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The Performance Structures 10
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Provincial and regional leadership accountability Ministry of
Health and Long-Term Care Cancer Care Ontario Cancer Quality
Council of Ontario Other regional cancer providers (e.g., home
care, hospice, etc.) Provincial Clinical Programs with Clinical
Leads Regional Cancer Programs led by Regional Vice Presidents
Clinical Accountability Prevention Family Medicine Screening Cancer
Imaging Pathology and Laboratory Medicine Surgical Oncology
Systemic Treatment Radiation Therapy Psychosocial Oncology Patient
Education Survivorship Palliative Care 11 Provincial Leadership
CouncilClinical Council
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The performance improvement cycle Using key levers to improve
the system Horizon-scanning and championing innovation Identifying
quality improvement opportunities Standardizing development and
guidelines Developing and implementing improvement strategies
Monitoring performance 12
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Setting the performance priorities Meant to drive performance
in the cancer system in areas that need improvement Priorities are
determined annually Access/Wait times Evidence-based clinical
priorities (e.g.: thoracic surgery guidelines, pathology reporting)
Provincial priorities (e.g.: colorectal cancer screening program)
Proposed/approved by: clinical expert panels programs at CCO
Regional Cancer Programs 13
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Indicator selection and target setting Indicators must be: in
alignment with OCPIII and accountability agreements actionable for
the Regional Cancer Programs areas requiring significant
improvement provincially and/or in at least 5 regions capable of
data updates quarterly/annually and lag of 3 months or less 14
Targets: Expert panels recommend targets designed to improve
quality Program areas set provincial targets using evidence and
consensus Programs determine ultimate or maximum target first then
set annual targets Annual target must be achievable by at least 50%
of the regions by year end Targets approved by Clinical Council and
Provincial Leadership Council
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15 Prevention Family doctor/ health centre Routine screening
Hosp or SMRCC to undergo tests Cancer not diagnosed Diagnosis of
cancer Radiation Systemic End of treatment CureSurvivorship
Palliative/Supportive care Terminal care Death Relapse Continuing
treatment Goes to Referred to Long-term monitoring and follow up
Surgery Considers the full Cancer continuum
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Example of a priority indicator Systemic Treatment Referral to
Consult (RCC) 16 - one target for all - Confidence intervals - Rank
order Shows relative position against target and change from
previous period
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From indicators to motivating performance in the Field How do
we do it without line authority? 17
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Motivate through passion for the cause - a growing demand for
care It is estimated that will develop cancer in their lifetime 45%
of males 40% of females and Incidence + Prevalence Chronic Disease
18
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Motivate with credibility - clinical engagement throughout
19
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20 Motivate through formal structures for accountability
Administrative and Clinical Leadership
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Motivate with money - Contracts/Agreements 21 Purpose is to
clearly lay out the roles and obligations of all parties: Volume
Funding Performance requirements Management of performance
Quarterly reviews Reconciliation Funding adjustments (volume
re-allocations) Quality and reporting requirements
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22 Motivate through regional participation - the RCP Working
together to ensure that every patient, regardless of where they
live, can rely on high quality cancer care as close to home as
possible. An alliance is formed. patients & clients Cancer
Centre Hospital PHUs Other Health Care Providers Physicians
Academic Centres CCACs Palliative Care ResearchPrevention Screening
Acute Care Supportive Care
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23 Motivate with data - comparative reporting
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Motivate through healthy competition - overall ranking of RCPs
24 Z Score Ranking: relative distance between the centres
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Critical Success Factors 25
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Strong policy and planning capacity 26
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As RVP I am responsible for the quality and performance of the
Program. Dr. Craig McFadyen, RVP Central West / Mississauga Halton
Regional Cancer Program 27 Regional Vice Presidents (RVP) are key
to leading the Regional effort
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A must a strong IT/IM backbone Information Strategy Framework
28 Innovation Informatics Instrument the System Infrastructure
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Monitoring tools 29 Regional Cancer Scorecard
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30 Quarterly Performance Reviews (text, data, voice) dialogue
key process in driving accountability and improving performance
provides a focus for accountability designed to be efficient for
CCO and regions to administer reinforces need for continuous
attention attended by RCP partners (Alliance) embeds how can CCO
help tool for the RVP clearly identified follow-up
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Culture of public reporting on performance 31 MOHLTC Wait Times
site Cancer System Quality Index (CSQI) CCO Web site
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A watch-dog - CSQI 2012 summary Cancer Quality Council of
Ontario 32
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A mustmany partnerships 33 Health care providers
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A mustinfrastructure/capacity 34
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A mustgood leaders who are: Passionate Creative Change agents
Influencers Motivators Thinkers Etc. 35 dissatisfied with current
performance performance managers, not performance reporters
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There is always variation in performance? Hospital/ Program
size - too big and complex or too small and lack the infrastructure
Competing mandates - consumed with major capital developments,
issues in other non-cancer portfolios or academic pursuits Host
Hospital Issues- experiencing major financial difficulties, is
under review, or cant allocate appropriate supporting resources
Infrastructure lack of treatment and/or clinic space, equipment
needs replacement, information management systems are too old
Health Human Resources short staffed and/or face physician
shortages Seasonal variation Q2 includes the summer months / Q3
includes Christmas when operations slow down or shut down in some
cases Information stakeholders dont trust the data Leadership
performance / style 36
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37 Whats next? Expanding funding levers through Health System
Funding Reform Pay for performance Sustainability metrics More
quality indicators tied to volume contracts Dealing with
project/initiative related indicators that need qualitative
scoring