Welcome to Cancer Care Ontario
September 11, 2013
Garth Matheson
CAPCA - COO Roundtable
We do more than Cancer now
Core Competencies
Cancer
Access
to Care
Chronic
Kidney
Disease
Driving performance and quality
As
mandated
by the
Cancer Act;
Ontario
Cancer Plan
III
Building on
Ontario’s
Wait Time
Strategy
Ontario
Renal
Network
launched
June 2009;
Performance
Management and
Management Cycle
Health System
Policy Expertise
Standards
and Guidelines
Public Reporting
and Transparency
Clinical Engagement
and Alignment
Regional Partnerships
IM/IT
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Vision and Mission
Our new Vision
Working together to create
the best health systems in
the world
Our new Mission
Together, we will improve the
performance of our health
systems by driving quality,
accountability, innovation,
and value
3
New Corporate-wide Areas of Focus
Patient-Centred
Care
Prevention of
Chronic Disease
Integrated Care
Value for
Money
4
Knowledge Sharing
& Support
Organizational Structure
Board of
Directors
President and
CEO
Vice
President,
Ontario
Renal
Network
Vice
President,
Chief
Financial
Officer
Vice President,
CIO
Vice President,
Prevention and
Cancer Control
Vice President,
Corporate
Services, General
Counsel and Chief
Privacy Officer
Vice President,
Communications
5
Audit and Finance
Committee
Vice President,
Clinical
Programs and
Quality Initiatives
Vice
President,
Planning and
Regional
Programs
14 Regional
Vice
Presidents
14 Local Health Integration Networks =
14 Regional Cancer Programs
Population = 13.5M
~ 65,000 new cases
~ 25,000 deaths
17 facilities delivering
radiation (103 Linacs)
77 facilities delivering
chemo
6
Cancer Survival in Ontario
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The Ontario Cancer Plan III (2011 – 2015)
S I X STRATEGIC PRIORITIES
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
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CCO does not operate facilities or deliver care
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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
The Performance Structures
10
Provincial and regional leadership accountability
Ministry of Health and Long-Term Care
Cancer Quality
Council of Ontario
Cancer Care Ontario
Provincial Leadership Council
Clinical Council
Clinical Accountability
Regional Cancer Programs
led by Regional Vice
Presidents
Other regional cancer
providers (e.g., home care,
hospice, etc.)
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Prevention
Family Medicine
Screening
Cancer Imaging
Pathology and Laboratory
Medicine
Surgical Oncology
Systemic Treatment
Radiation Therapy
Psychosocial Oncology
Patient Education
Survivorship
Palliative Care
Provincial Clinical
Programs with
Clinical Leads
11
The performance improvement cycle
Using key levers to improve the system
Identifying quality
improvement opportunities
1. Data/Information
Monitoring
performance
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Incidence, mortality, survival
Analysis
Indicator development
Expert input
Horizon-scanning
and championing
innovation
4. Performance Management
2. Knowledge
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Institutional agreements
Quarterly review
Quality–linked funding
Clinical accountability
Research production
Evidence-based guidelines
Policy analysis
Planning
3.Transfer
Developing and
implementing
improvement
strategies
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Publications
Practice leaders engaged
Policy advice
Public reporting
Technology tools
Process innovation
Standardizing
development
and guidelines
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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
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
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
14
Considers the full Cancer continuum
Prevention
Goes to
Routine
screening
Family doctor/
health centre
Referred to
Hosp or SMRCC
to undergo tests
Referred to
Cancer not
diagnosed
Diagnosis of cancer
Surgery
Palliative/Supportive care
Radiation
Systemic
End of treatment
Continuing treatment
Long-term monitoring
and follow up
Relapse
Terminal care
Cure
Survivorship
Death
15
Example of a priority indicator
Systemic Treatment – Referral to Consult (RCC)
- one target for all
- Confidence intervals
- Rank order
Shows relative position
against target and
change from previous
period
16
From indicators to motivating
performance in the Field
How do we do it without line authority?
17
Motivate through passion for the cause a growing demand for care
It is estimated that
45% of males
and
40% of females
will develop cancer
in their lifetime
Incidence + Prevalence
Chronic Disease
18
Motivate with credibility clinical engagement throughout
19
Motivate through formal structures for accountability
CCO Chief Executive Officer
Hospital CEO
Provincial VP,
Planning and
Regional Programs
Provincial VP
Clinical Programs
RCP leads
in Surgery
Surgery
RVP 1
RVP 2
Radiation
RCP leads
in Radiation
Systemic Treatment
Cancer Staging
RVP 3
Palliative Care
RCP leads
in Systemic
Treatment
Path & Lab Medicine
Nursing + HR Planning
Patient Education
PEBC
Etc.
Etc.
Administrative and Clinical Leadership
20
Motivate with money - Contracts/Agreements
• 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
21
Motivate through regional participation - the RCP
Cancer Centre
Hospital
Academic
Centres
Research
Palliative Care
CCACs
Prevention
patients
& clients
Supportive
Care
PHUs
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.
Screening
Acute Care
An alliance is
formed.
Physicians
Other
Health Care
Providers
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Motivate with data comparative reporting
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Motivate through healthy competition overall ranking of RCPs
Region
RANK
Central
1
Central East
2
Waterloo Wellington
3
Central West & Mississauga Halton
4
South East
5
North West
6
Hamilton Niagara Haldimand Brant
7
North Simcoe Muskoka
8
Toronto Central North
9
Erie St. Clair
10
Champlain
11
North East
12
Toronto Central South
13
South West
14
Z Score Ranking:
relative distance
between the
centres
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Critical Success Factors
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Strong policy and planning capacity
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Regional Vice
Presidents (RVP)
are key to leading
the Regional effort
“As RVP … I am responsible for the quality
and performance of the Program.”
– Dr. Craig McFadyen, RVP
Central West / Mississauga Halton Regional
Cancer Program
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A must… a strong IT/IM backbone
Information Strategy Framework
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Innovation
Informatics
Instrument the System
Infrastructure
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Monitoring tools
Regional Cancer Scorecard
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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
• MOHLTC Wait Times site
• Cancer System Quality Index
(CSQI)
• CCO Web site
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A watch-dog - CSQI 2012 summary
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Cancer Quality Council of Ontario
A must…many partnerships
Health care
providers
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A must…infrastructure/capacity
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A must…good leaders who are:
 Passionate
 Creative
 Change agents
 Influencers
 Motivators
 Thinkers
 dissatisfied with
current performance
 performance
managers, not
performance reporters
 Etc.
35
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 can’t 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 don’t trust the data
• Leadership – performance / style
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What’s 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
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So Much More to do