The priority indicators for the 2022/23 Quality Improvement Plan (QIP) program were recently shared.
While no palliative care specific indicators were identified, timely access to palliative care can positively impact some of the 2022/23 system level indicators that were announced.
Let’s look at the alternative level of care (ALC) indicator as one example. The percentage of inpatient days designated as ALC is an indicator for both Ontario Health Teams to address for their collaborative QIP submissions and for hospitals to address for their individual QIP. However, we know moving this big dot in the desired direction will require the collaborative effort of many health system partners. As the image below suggests, the movement of outcome measures first requires the movement of process measures, and this necessitates the identification of change ideas to be tested first on a small scale and then over time, fully transitioned in day-to-day standard operating procedures.
These change ideas or interventions will shape the tasks and activities that become performed on a regular basis by health care staff and clinicians in their respective settings. If designed well, these tasks and activities produce outputs or results that are “handed-off” to other organizations or members of the collaborative team to provide continuity in the desired management of the health condition.
To ensure our efforts to achieve our outcome goals are not having negative consequences elsewhere on the Quadruple Aim factors (e.g., increased cost or increased workload), it is important to monitor balancing measures accordingly.
One example to put this theory into practice could be
for a LTC home to set an outcome goal to reduce avoidable visits to the
emergency department for their residents.
A corresponding process measure may be to capture
the percentage of residents who have been identified with palliative care needs and to
build change ideas around this. Change ideas could include a focus on additional
education for LTC providers to enhance their palliative care competencies or providing
education to residents and their families that help empower them to become more
actively engaged in their care. Timely access to palliative care can result in better
symptom control, end of life care planning, and supports for the resident and their
family while also helping to reduce avoidable visits to the emergency room at
end of life.
As process interventions mature and build momentum,
downstream system level priorities like ALC will be affected.
If you are working on improving aspects of palliative care in with your team or organization feel free to join our Palliative Care Implementation Support CoP Group. Here we share resources, tips, tools and upcoming webinars.
Comment below to share your examples of change ideas or
interventions that you have done in the past or are planning to contribute to
achieving a system level priority.