Evidence of Value

D2D 5.1: Getting Started and Changing Gears

AFHTO members have just released the 7th iteration of their performance measurement report, Data to Decisions 5.1. Voluntary participation in team-level measurement remains high. 90% of members have contributed so far, with over 60% in D2D 5.1. This makes D2D 5.1 a unique picture of primary care across the province, at the LHIN level, and (for the second time) at the sub-region level. Many AFHTO members are going even further than that. 43 teams chose to unmask themselves and are again openly sharing their data with their peers. Some are even putting their reports out on their public websites or sharing them in social media! AFHTO members have clearly gotten started with measurement.

The North Stars

The FHTs of the North East LHIN are a shining example of where measurement can take us. The Northeastern Ontario Family Health Teams Network (NEOFHT) continue to lead the way in D2D. 17 of their 27 teams participated in D2D 5.1 – the fourth time in a row they had the highest number of participating teams in the province (the runner up was South West LHIN at 13 teams). Several of our tiny-but-mighty regions are also shining bright; 100% of the teams in Waterloo-Wellington and 86% of the teams in Mississauga-Halton contributed data.

With this level of sustained commitment, it is not surprising that the 27 NEOFHT teams are taking some big next steps together.  Having seen how D2D helped them compare at a team level, they wanted to do more. They wanted to be sure that any patient going to any team in the North East could expect to have the same kind of care, no matter where they went. In partnership with their QIDSS, the FHT Executive Directors started by agreeing on common indicators to track how they are doing on the 9 most common programs offered in their teams. The impressive thing is that they’re not just talking about it; they’re putting their money where their mouth is. They’re combining QI forces and resources to bring all 27 teams up to the same level in technical tools and training. This ensures that everyone can capture all the data the same way, making it not only possible but easier and more efficient to compare progress and learn from each other.

The North East LHIN teams are not alone. The Champlain LHIN teams have also invested in sharing common program-level data between their 21 teams. The teams of ESC openly share their quality improvement projects to learn from each about what is working to improve care among their 9 teams. These are clear signs that measurement is becoming a part of the AFHTO culture across the province.

Changing gears: Learning from each other

AFHTO members are proud of their progress in building measurement into their culture, and they are dissatisfied that this has not yet led to improvement in performance across all teams. AFHTO members are not content to come in 9th place[i], after the gold, silver and bronze medals have been handed out. We are not content to get the participation ribbon. Measurement is the starting gate for improvement, but it is not the finish line. AFHTO has made it a strategic priority to demonstrate the value of team-based primary care in Ontario. That is where D2D started. Now AFHTO is ready to change gears and take on the improvement challenge in earnest.

We are not starting with an empty tank. AFHTO members have strong relationships with their patients and with each other. As Barbara Starfield observed, relationships are the unique and powerful contribution of primary care to a sustainable healthcare system. AFHTO will be leveraging the networks built over the past five years in the form of at least ten leadership committees involving members from teams across the province. These long-standing relationships give AFHTO members a solid grounding to support their improvement efforts.

Those relationships are already paying off.

  • OntarioMD has been partnering with AFHTO from the beginning when they produced D2D 1.0. Since then, AFHTO and OntarioMD have been working together to improve access to EMR data to help teams improve the health outcomes of their patients.
  • Through partnerships with Community Health Ontario and LEADS Canada, AFHTO is investing in leadership, which is just as important in improvement as measurement.
  • AFHTO has partnered with private and not-for-profit companies alike to offer LEAN and practice facilitation training to AFHTO members (from KM&T and the Centre for Effective Practice, respectively).
  • Research partnerships continue to buoy AFHTO’s efforts. Most recently, AFHTO has partnered with Dr Judith Belle-Brown (president-elect of NAPCRG and long-standing primary care researcher from Western University) to help members learn from each other what it is about teams with high and ever improving performance that other teams can replicate to have similar outcomes.

D2D was AFHTO’s way to get started by measuring. AFHTO is now changing gears to move beyond measurement to improved outcomes. We’re continuing on our journey to excellent team-based care for #EveryCommunityEveryPatient in Ontario.

See an infographic summary of the D2D 5.1 results here.

See the aggregate data for each LHIN region here.

[i] In 2017, Canada came in ninth out of eleven countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, and the US) in the Commonwealth Fund’s annual Health Care System Performance Rankings.