RGP Operational Plan 2019-2020€¦ · RGP Operational Plan 2019-2020 | 3 Introduction The Regional...

Submitted June 28, 2019

RGP Operational Plan

2019-2020

Table of Contents Introduction.......................................................................................................................................... 3

Strategic Priority #1: Transforming Specialized Geriatric Services ...................................................... 4

Strategic Priority #2: Fostering Excellence in Senior Friendly Care ..................................................... 6

Budget and Resource Requirements .................................................................................................... 9

Appendix 1: RGP of Toronto Strategic Plan (2017-2020) ................................................................... 10

Appendix 2: FY2019-2020 Operating Calendar .................................................................................. 11

Appendix 3: Transforming SGS Action Plan – 2019/20 Priorities Poster ........................................... 13

Appendix 4: Performance Indicator Framework ................................................................................ 14

Appendix 5: SGS Utilization Metrics Inventory .................................................................................. 15

Appendix 6: sfCare Knowledge-To-Practice Map............................................................................... 16

Appendix 7: FY2019-2020 RGP Board Quarterly Score Card ............................................................. 17

RGP Operational Plan 2019-2020 | 3

Introduction The Regional Geriatric Program of Toronto (RGP) is a leader in developing specialized geriatric services (SGS). The RGP provides guidance at the regional level in organizing and supporting best practice in specialized geriatric services, aligned with the vision of population health planning (see Appendix 1). In 2018/2019, the RGP executed a plan towards an enhanced role in optimizing senior care across TC LHIN. The 2019/2020 operating plan activities will continue to build upon innovative approaches to support care of frail seniors. In addition, the RGP will contribute to provincial initiatives by providing leadership to selected elements of the RGPs of Ontario strategic plan, Behavioral Supports Ontario work plan and contribute to the dementia strategy. To accomplish this, the RGP will work in partnership with the TC LHIN and emerging Ontario Health Teams in the care of frail older adults and their caregivers through the plan outlined below (see also Appendix 2 for Operating Calendar). The RGP will continue to leverage its experience, authority, relationships, and human resources to provide seamless integration of services for older adults across the health care system. The RGP will transform the delivery of SGS by increasing access, improving quality, and driving efficiency.


Strategic Priority #1: Transforming Specialized Geriatric Services (see Transforming SGS Action Plan Priorities Poster in Appendix 3)

A. BUILD CAPACITY FOR RAPID ACCESS APPOINTMENTS FY 2019/20 Initiatives: 1. Determine the successes and challenges of

geriatric services currently offering rapid access appointments

2. Identify needs of primary care with regard to access

3. Develop a rapid access model including patient identification criteria, triage practices and process

4. Pilot at identified trial sites and gather evaluation data

How will we measure success in 2019/2020? • Increased number of

appointments available for rapid access at identified sites

Target >10% of all appts are rapid access

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

B. IMPLEMENT BEST PRACTICE INTEGRATION OF TELEHEALTH TO INCREASE ACCESS TO

SPECIALIZED GERIATRIC CONSULTATION AND ASSESSMENT FY 2019/20 Initiatives: 1. Identify champions in the geriatric community

with prior telehealth implementation experience 2. Host preliminary best practice webinar/info

session(s) 3. Identify pilot sites 4. Implement telehealth model and associated

metrics

How will we measure success in 2019/2020? • Uptake of telehealth use

by SGS providers

Target 10% increase v. baseline

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

A1

A4

A3

B1

B2

B3 / B4

A2


C. ESTABLISH AN AMBULATORY CLINIC COMMITTEE OF PROVIDERS FY 2019/20 Initiatives: 1. Establish committee, and develop wait time

reduction strategies 2. Clinic sites to begin collection of relevant

Performance Improvement Framework indicators

How will we measure success in 2019/2020? • Participation of Geriatric

Clinics in the TC LHIN • Wait time reduction

strategy developed

Target

90%

Wait time action plan defined

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

D. SCALE-UP PERFORMANCE INDICATOR DATA COLLECTION

FY 2019/20 Initiatives: (see Performance Indicator Framework in Appendix 4) 1. All SGS partner sites to collect utilization data

(see Appendix 5) 2. Expand and review collection of outcome

indicators to all relevant SGS partners 3. Review system-level utilization data from the TC

LHIN

How will we measure success in 2019/2020? • All identified sites are

participating

Target 100% of partners collect and submit data

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

E. COORDINATE AND INTEGRATE GERIATRIC MEDICINE AND GERIATRIC PSYCHIATRY WITH AN INITIAL FOCUS ON OUTREACH SERVICES

FY 2019/20 Initiatives: 1. Determine best practices and characteristics of

successful integrated health systems from the literature and our community

2. Draft a vision for integration of geriatric medicine and psychiatry outreach

3. Identified outreach teams to perform integration self-assessment

4. Establish expected team processes that reflect integration based on published criteria

5. Initiate geriatric medicine and psychiatry integrated outreach model at select sites

How will we measure success in 2019/2020? • Improvement on System

Integration Scale

Target 1 pilot initiative launched

C1

D1

D3

D2

C2


Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

Strategic Priority #2: Fostering Excellence in Senior Friendly Care In collaboration with provincial partners, the RGP of Toronto developed and launched the Senior Friendly Care (sfCare) framework in 2017. The goal of senior friendly care is to achieve the best possible health outcomes for older adults. The sfCare framework provides the foundation for achieving this goal through guiding principles and defining statements which are intended to foster improvements in care across the system and inspire greater collaboration between older adults and their caregivers, care providers, and organizations. In 2019/20, the RGP will lead the implementation of sfCare framework across the province (see Appendix 6).

E1

E2

E3

E4

E5


A. DEVELOP AND DISSEMINATE NEW EDUCATIONAL RESOURCES TO SUPPORT THE IMPLEMENTATION OF SFCARE

FY 2019/20 Initiatives: 1. Leverage end-user feedback from sfCare

Learning Series intro level for clinicians materials to further develop the sfCare Learning Series, including a new intro-level module, as well as single-page resources (such as tip sheets)

2. Execute a launch campaign. 3. Evaluate and consult clinical experts to inform

content. Conduct end-user testing on draft learning materials, and refine based on results.

How will we measure success in 2019/2020? • End-user satisfaction

Target Net promoter score of >50

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

B. DEVELOP AN AWARENESS CAMPAIGN TO DRIVE THE UPTAKE OF ALL SFCARE TOOLS

FY 2019/20 Initiatives: 1. Develop a communication plan with strategic

messaging for different audiences and platforms (newsletter, social media, web) for newly developed and existing educational resources and tools

2. Execute at least one engagement campaign, such as “Delirium Prevention Poster Translation” (invite clinicians to send a translation for the poster, and we will publish it)

3. Engage targeted professional associations as campaign partners

4. Publish articles about SFH ACTION and the sfCare Framework in peer-reviewed journals.

5. Redevelop sfCare website

How will we measure success in 2019/2020? • Uptake of materials, and

increase in information-seeking about sfCare, as evidenced by a 10% increase in click rates on rgptoronto.ca

Target >1,625 (average monthly) visits to website >550 (average monthly) visits to resources page on website

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

B1 / B2 /B3

B4

B5

A1

A3

A2


C. DEVELOP DELIRIUM QUALITY STANDARDS IN COLLABORATION WITH HQO

FY 2019/20 Initiatives: 1. Participate on the HQO expert panel as co-chair

to provide experience and knowledge to inform the development of Delirium Quality Standards

2. Update relevant RGP resources and materials as appropriate, based on published standards to encourage adoption across the broader provincial system

How will we measure success in 2019/2020? • Dedicated leadership and

support during the process • Completion of draft

delirium quality standard

Target Final draft of quality standards by end of Q4

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

D. PLAN SFCARE ACCELERATING CHANGE TOGETHER IN ONTARIO HEALTH TEAMS FY 2019/20 Initiatives: 1. Gain an understanding of the requirements and

needs of the new Ontario Health Teams based on Ministry-outlined guidance materials and assessment criteria

2. Refresh the ACTION program materials with updated language and focus points

3. Engage OHTs to participate in ACTION-HT change leadership training

How will we measure success in 2019/2020? • Partnerships with new

OHTs

Target Gain buy-in from at least one OHT to participate in training

Q1 FY1920 Q2FY1920 Q3FY1920 Q4FY1920

C1 (and beyond)

D1

D2

D3

C2 (and beyond)


Budget and Resource Requirements The current operating budget for April 1, 2019– March 31, 2020 is summarized below.

RGP Program Operations and Funded Hospitals 2019-20 Budget

Program Operations $ 1,379,034 Baycrest $ 1,115,183 North York General Hospital $ 980,247 Sunnybrook Health Sciences Centre $ 1,250,814 UHN - Toronto Rehabilitation $ 1,941,498 UHN - Toronto Western Hospital $ 499,981 Providence Healthcare $ 907,989 St. Michael's Hospital $ 655,362 GEM $ 1,097,275 TOTAL RGP Operating Budget $ 9,827,383

Provincial Geriatric Leadership Office budget as per MSAA for April 1, 2019 to March 31, 2022 (Community One Time Expense)

$ 700,000


Appendix 1: RGP of Toronto Strategic Plan (2017-2020)


Appendix 2: FY2019-2020 Operating Calendar

A M J J A S O N D J F MSuccesses and challenges of current programsIdentify needs of primary careDevelop model/criteria/triage/ processesPilot model at SGS site(s)Identify champions with experienceHost webinar / info sessionsIdentify pilot sitesImplement with associated metricsEstablish committee and Standards of Service DeliveryCollection of PIF IndicatorsAll partner sites to collect util ization dataExpand outcome indicator collection to all relevant siteReview TC LHIN system-level util ization dataDetermine characteristics of successful integrated health systemsLandscape assessment of psychogeriatric outreach servicesDevelop a vision for integration of geri med & geri psychEstablish team process/best practicesPilot at select site(s)

Expand capacity for rapid access appointments

Implement best practice integration of established telehealth programs to increase access to specialized geriatric consultation and assessment

Establish an ambulatory clinic committee of providers

Scale-up performance indicator data collection

Coordinate and integrate geriatric medicine and geriatric psychiatry with an initial focus on outreach services

Transforming Specialized

Geriatric Services

(SGS)

Q1 Q2 Q3 Q4


A M J J A S O N D J F MLeverage end-user feedbackPlan/execute launch campaignResearch/expert consultation to inform content and refinementDevelop communication plan with audience/platform-specific messagingExecute 1+ engagement campaignEngage targetted professional associations as campaign partnersPublish journal article(s) about SFH ACTION and sfCare FrameworkRedevelop sfCare websiteParticipate on the expert panel as co-chairUpdate RGP resources based on published HQO StandardsUnderstand requirements and needs of OHTsRefresh ACTION program material with OHT language and focus pointsEngage OHTs to participate in ACTION-HT

Q1 Q2 Q3 Q4

Develop and disseminate new educational resources to support the implementation of sfCare

Develop delirium quality standards in collaboration with HQO

Plan sfCare Accelerating Change Together in Ontario Health Teams

Fostering Excellence in

Senior Friendly Care

Develop an sfCare awareness campaign to drive the uptake of all sfCare tools


Appendix 3: Transforming SGS Action Plan – 2019/20 Priorities Poster


Appendix 4: Performance Indicator Framework

POPULATION HEALTH EXPERIENCE OF CARE APPROPRIATENESS AND AFFORDABILITY

PROCESS

Mobility (Gait speed) Patient Experience: Engagement in Care and Satisfaction

Caregivers: Preparedness for caregiving

Medication Reconciliation and Appropriateness (Parking Lot)

Utilization: Cases(Referrals/Visits, Admissions, Assessments,

Clients)

Wait timeUtilization: Episode of Care(Pt days, LOS, Occupancy)

OUTCOMEPartner Engagement

(Stakeholder and partner satisfaction, incl primary care)

ALC (SGS / Organization)

PROCESS Wait time

Pt QOL ALC

Subjective Health StatusOUTCOME

SYSTEM PERFORMANCE

ORGANIZATIONAL PERFORMANCE

PROCESS

SPECIALIZED GERIATRIC SERVICES PERFORMANCE INDICATOR FRAMEWORKDOMAINS OF MEASUREMENT

PATIENT & CAREGIVER LEVEL

OUTCOME


Appendix 5: SGS Utilization Metrics Inventory

Other LHIN

BAY SHSC TRI SHS-B TWH PROV STM MGH SJHC SHS TGH GRACE WP NYGHOUTREACH TEAMSWait time x x x x xClinical FTE - physicians x x x x xClinical FTE - other health professionals x x x x xReferrals x x x x xAcceptances/Admissions x x x x xTotal Visits x x x x xDAY HOSPITALS Falls ProgWait time x x x x xClinical FTE - physicians x x x x xClinical FTE - other health professionals x x x x xApproved spaces x x x x xReferrals x x x x xAcceptances/Admissions x x x x xTotal Visits x x x x xGERIATRIC CLINICSWait time x x x x x x x x x x xClinical FTE - physicians x x x x x x x x x x xClinical FTE - other health professionals x x x x x x x x x x xAdmissions x x x x x x x x x x xTotal Visits x x x x x x x x x x xACEBeds x x x xAdmissions x x x xPatient days x x x xSeparations/ Discharges x x x xAverage Length of Stay x x x xOccupancy Rate x x x x% ALC days on ACE unit x x x xGRU & GATUWait time x x x x xBeds x x x xAdmissions x x x x xPatient days x x x x xSeparations/ Discharges x x x x xAverage Length of Stay x x x x xOccupancy Rate x x x x% ALC days on GRU/GATU Unit x x x x xCONSULTATIONSClinical FTE - physicians x x x x x x x x x xClinical FTE - other health professionals x x x x x x x x x xPatients Seen x x x x x x x x x xGEMNumber of FTEs x x x x x x x xGEM Assessments x x x x x x x xPatients Admitted x x x x x x x x

RGP of Toronto SGS Metrics Inventory

Toronto Central

Com

bine

d w

ith T

RI


Appendix 6: sfCare Knowledge-To-Practice Map


Appendix 7: FY2019-2020 RGP Board Quarterly Score Card

Strategic Priority Indicator Target Q1 Q2 Q3 Q4 Key Commentary

Patient and Family Informed Strategic Plans

Comprehensive engagement plan across all initiatives prioritizing: - Performance and Quality Steering Committee (PAQSC) - Transforming SGS - Senior Friendly Care

>75% of intiatives include Patient/Family input

Expand capacity for rapid access appointments

>10% of all appointments are rapid access

Implement best practice integration of established telehealth programs to increase access to specialized geriatric consultation and assessment

10% increase in utilization v. baseline

90% Clinic participationWait time action plan defined

Scale up performance indicator data collection

100% of partners collect and submit data

Coordinate and integrate geriatric medicine and geriatric psychiatry with an initial focus on outreach services

1 pilot initiative launched

Develop and disseminate new educational resources to support the implementation of sfCare

NPS >50

>1625 avg monthly visits to website

>550 average montly visits to Resources page of website

Develop delirium quality standards in collaboration with HQO

Final draft of quality standards by end of Q4

Plan sfCare Accelerating Change Together in Ontario Health Teams (OHT)

Buy-in from ≥1 OHT to participate

FY1920 Operational Plan Dashboard and Overview

1) Transforming Specialized Geriatric Services (SGS)

2) Fostering Excellence in Senior Friendly Care

Establish an ambulatory clinic committee of providers

Develop an sfCare awareness campaign to drive the uptake of all sfCare tools

Driving system change to advance the quality of care for older adults living with frailty. Innovating bold solutions to complex care problems.

Better health outcomes for frail older adults

www.rgptoronto.ca

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