Improving access to primary care mental health and
addictions services is a top priority for Waterloo Wellington LHIN’s (WWLHIN) Cambridge-North
Dumfries (C-ND) sub-region.
To achieve meaningful improvement in this area, health and
community organizations in Cambridge-North Dumfries have come together to work
on a Collaborative Quality Improvement Plan (C-QIP). This C-QIP is one of four that
was submitted to Health Quality Ontario by the WWLHIN as an innovative pilot
project to advance collaborative quality improvement.
C-QIPs are multi-organizational QIPs focused on a cross-sector issue.
They are coordinated at the sub-region level and drive system-level change.
They represent joint public commitments by staff and organizational boards
Health Quality Ontario had a chance to catch up with Kerry-Lynn
Wilkie, Health Link Director at Cambridge-North Dumfries to talk about the
process of developing a C-QIP and lessons learned to date.
How did you identify
what your sub-region’s C-QIP should focus on?
Back in 2014, many years prior to the C-QIP team being
formed, the Cambridge-North Dumfries Health Link came together to identify
health care priorities to inform our Health Links Business Case.
Through extensive consultations with providers, clinicians, patients
and community agencies, and a review of local emergency department hospital
data, it became clear that improving access to primary care mental health and
addictions services should be one of the top priorities for our sub-region.
In 2015, a Cambridge-North Dumfries Health Link working
group was formed to determine how to increase patients’ access to mental health
and addiction services in primary care. In 2016, the working group membership
broadened to include additional agencies from primary care, social services,
and addiction services. This group had been working together for about a year
and a half when it evolved into a C-QIP with guidance from WWLHIN, Health
Quality Ontario and the external consultant already working with the
Cambridge-North Dumfries Health Links steering committee.
make up the C-QIP team?
Thirteen willing organizations identified by the WWLHIN were
mobilized to participate. Each organization selected one or more representatives
to be part of our team including frontline staff, mental health providers,
mid-managers, executive directors, and CEOs.
Langs Community Health Centre (CHC) leads the C-QIP and is
supported by the following organizations:
- Cambridge Memorial Hospital
- Canadian Mental Health Association – Waterloo
- Grandview Family Health Team
- Heritage Family Health Organization (FHO)
- House of Friendship
- Stonehenge Therapeutic Community
- St. Mary’s Counselling Services (until May 31
- Thresholds Homes and Supports
- Two Rivers Family Health Team (FHT)
- Waterloo Region Nurse Practitioner Led Clinic
- Waterloo Wellington LHIN
Representatives of the
Integration of Mental Health and Addiction Services with Primary Care C-QIP Working
What were your first
steps in getting the C-QIP off the ground?
Working on a C-QIP is a new experience for some community
organizations on our team and some don’t have quality improvement staff or
committees. We decided to conduct two education sessions with board
member/governors of participating organizations and other health and social
service agencies in the sub-region.
The goal of the education sessions was to talk about what a C-QIP is
and to strengthen the knowledge of board members/governors about the current
state of mental health and addictions services available in the sub-region and
the challenges that exist.
About 120 board members/governors and senior staff attended
the two education sessions. In 2019, a third education session will be held
focused on children and adolescent mental health and addictions services.
To further support board members/governors, we also put
together a 2-3 page briefing note to describe the C-QIP and what each
particular agency would be signing off on. Each board needed to understand what
the overall plan for the C-QIP was, what change ideas were going to be
implemented and how the C-QIP aligns with their agency’s work. This gave boards
the information they needed to feel confident to formally commit to the C-QIP.
How does the C-QIP
team work together?
The C-QIP is divided into three workstreams that collectively
aim to improve access to primary care mental health and addictions services.
Our C-QIP team members get to choose
which workstream they want to work on, which increases our team’s engagement.
Each workstream working group has a lead representative that schedules meetings
for their workstream and moves the work forward.
On a regular basis, we have a two-hour meeting. In the first
hour, the three workstream working groups meet separately to discuss their
progress and challenges to date. In the second hour, we all come together as a
larger group. We find that this is very efficient and makes the most of
We have also developed a dashboard that shows our quarterly progress
for our three C-QIP workstreams. The dashboard is a helpful tool that can be
brought back to our partner organizations’ boards and staff members to reinforce
the value of working on the C-QIP. We also use the dashboard to report back to our
Annually, we create a two-page high level summary that is
shared with the organizations’ boards.
Did you experience any
At first, we found that some organizations were hesitant to
get on board. They were unsure how the C-QIP would affect staff time and other
organizational priorities. The briefing notes provided helped to address this.
Scheduling meetings for a large group of people across many
organizations is always challenging. We tried different meeting days and times
and we found what works for our group. There is no cookie cutter approach.
We’ve also been flexible and changed meeting times when necessary to ensure our
key players stay involved in the work.
We find that our two-hour meetings work well to allow the
three workstream working groups to collaborate in the first hour before coming
together as a large group in the second hour.
What has been your
Having all thirteen organizations formally sign off and
commit to the C-QIP has been a big success. We spent quite a bit of time
establishing relationships, providing education and ironing out schedules to
ensure we have the processes in place to bring this work forward.
Our partner organizations have done a great job identifying the right
people to be at the table. Since the C-QIP is rooted in pressing topics that
have come out of a clear need in our sub-region, it has brought highly engaged
people to the table with a vested interest in this work. Without their
eagerness and ability to drive this work within their own organizations, we
wouldn’t be able to make progress.
Since our work is divided up into three workstreams that
include some tangible work activities that we’ve achieved success with, we see
a sense of hope with our team. These small, quick wins have provided momentum
and excitement in our group. People are ready to sign off on year two and are
asking, “what’s next?”
What advice would you
give to other organizations who want to get involved in a C-QIP?
Ensure you have a lead organization in place and bring the
right stakeholders to the table who will be highly engaged in the work you are
doing. Build open communication and trusting relationships with your group.
Keep your expectations realistic and know that there may be a lot of
education and learning that needs to happen before you jump into working
Focus on one or two priorities, keep the work tangible and
ensure you can have some short-term quick wins to keep your group
motivated. If possible, take advantage
of pre-existing cross-sector tables to reduce redundancies and leverage
Ensure there is a formal structure in place for decision-making
and oversight and establish where the accountability lies. The boards of the
organizations involved are accountable for the C-QIP. Through the Service
Accountability Agreement process, the WWLHIN is having providers align their
organizations’ plans to the WWLHIN Annual Business Plan.
View the WW LHIN Briefing note outlining the sub-regional C-QIPs here.
You may also be interested in:
Improving health care delivery using C-QIPs: Spotlight on Waterloo Wellington LHIN