The Long Term Care (LTC) Branch has participated in a voluntary national accreditation process with Accreditation Canada for over 15 years, as one of the quality improvement and services excellence tools used by the Branch.
Accreditation Canada is a not-for-profit, independent organization accredited by the International Society for Quality in Health Care (ISQua). Accreditation Canada provides national and international health care organizations with an external peer review process to assess and improve the services they provide to their clients based on standards of excellence.
Accreditation is one of the most effective ways for health services organizations to regularly and consistently examine and improve the quality of their services. Health care organizations that participate in Accreditation Canada’s accreditation programs are evaluating their performance against national standards of excellence. These standards examine all aspects of health care, from patient safety and ethics, to staff training and partnering with the community to ensure the best possible care and service to clients.
LTC Homes in Ontario, that are accredited, receive supplemental funding from the Ministry of Health and Long Term Care (MOHLTC) as recognition for their accreditation status and as an incentive to participate in the accreditation program. This funding equates to $0.33 per resident day, or $85,640.00 annually for the four City of Ottawa LTC Homes. The costs of participating in the Accreditation Canada process are approximately $17,000 annually. Therefore, the full cost of the accreditation process is funded by the MOHLTC, with additional resources available to ensure appropriate quality improvement processes are in place.
This most recent accreditation process started in 2008 with a self-evaluation procedure. The self-evaluation involved the completion of questionnaires by all staff, measuring performance against the national standards in the categories of Patient Safety; Long Term Care Services; Medication Management; Infection Prevention and Control; Effective Organization and Employee Satisfaction. Resident and Family Satisfaction is evaluated through a different process on an annual basis.
The results from these questionnaires provided the starting point for the four LTC Branch Committees. These quality improvement committees had staff representation from across the four Homes, representation from Human Resources Services, Employee Health and Wellness, Financial Services, IT Services, community partners, residents and families. These Accreditation teams used the self-evaluation questionnaire results, and a review of the national standards against existing practices to identify the strengths and areas for improvement. These teams were then instrumental in identifying the actions to put in place to address all areas for improvement in advance of the Accreditation process.
From September 13th to 17th, 2009, Accreditation Canada’s external peer surveyors completed site visits of the four City of Ottawa, LTC Homes. Four surveyors spent five days reviewing the performance of the Homes, examining documentation, interviewing residents, families and staff and observing the daily operations.
The LTC Branch received full accreditation status in October 2009 for a period of three years, until October 2012.
In total, there are 412 national standards of excellence against which LTC Home’s are evaluated. The LTC Branch met 411 of the 412 standards. This is an exceptionally high rate of achievement for an organization. The following table summarizes the results by the quality dimensions used within the survey process:
OVERVIEW BY QUALITY DIMENSION
QUALITY DIMENSION |
MET |
UNMET |
TOTAL |
Population focus (Working with communities to anticipate and meet needs) |
19 |
0 |
19 |
Accessibility (Providing timely and equitable services) |
23 |
0 |
23 |
Safety (Keeping people safe) |
138 |
0 |
138 |
Worklife (Supporting wellness in the work environment) |
37 |
0 |
37 |
Client-centred Services (Putting clients and families first) |
33 |
0 |
33 |
Continuity of Services (Experiencing coordinated and seamless services) |
7 |
0 |
7 |
Effectiveness (Doing the right thing to achieve the best possible result) |
140 |
1 |
139 |
Efficiency (Making the best use of resources) |
14 |
0 |
14 |
Total |
411 |
1 |
412 |
Accreditation Canada identifies a number of required organizational practices within the 411 standards, that must be achieved to receive accreditation. These required organizational practices have been identified as areas of significant potential risk to resident and employee safety. These practices range in focus from medication storage and management, to ensuring a falls prevention program is in place to undertaking an annual prospective review of a resident safety risk. The LTC Branch met all of the required organizational practices mandated by Accreditation Canada.
The one unmet standard identified in the Effectiveness, Quality Dimension, relates to the review of policies and procedures following an infectious disease outbreak in a Home. Although a review process is undertaken following a disease outbreak, there was no documentation of this review evident during the on site survey. This process will be reviewed.
The surveyors commentary identified incredible strengths in the homes,
commenting specifically on the dedicated client-centred staff; strong
accessible leadership; effective delegated authority; extensive
staff involvement in facility committees; comfortable home-like environments;
commitment to client safety; effective ethics program; integrated quality
management program; comprehensive wellness program; TeleStaff scheduling
system; resident safety framework; strong committee structure that supports
communication and quality improvement and well developed community
partnerships.
The surveyors felt that one of the
key challenges facing the Long Term Care Branch was the many significant
changes that have been successfully undertaken in the past two years, including
the implementation of a new electronic resident
information system, implementation of a
new computerized staff scheduling system; TeleStaff, and implementation of a
new pharmacy system; Medisystem. Other
key changes are the continued changes that will be faced in the near
future such as the new LTC Homes Act, a new Ministry of Health and Long Term
Care (MOHLTC) Compliance review program and a new funding methodology with the
MOHLTC. They highlighted that the LTC Branch seemed particularly well poised to
deal with these changes due to the resilient staff and strong leadership.
The surveyor recommendations,
identified in the report, were to complete the evaluation of the
computerization enhancements, continue efforts to prepare for a pandemic
response; continue to prepare for future financial constraints and prepare for
anticipated health human resources shortages through the development of a
branch specific H.R. plan.
The LTC Branch will continue to use the Accreditation Canada standards as best practice standards in the development of new policies and procedures, and in measuring performance. As part of this ongoing relationship with Accreditation Canada, and as a requirement to maintain accreditation, the LTC Branch continues to submit data quarterly to Accreditation Canada, related to indicators for infection prevention and control, and for medication management. These are among the quality indicators monitored within the balanced scorecard framework utilized by the Branch to measure performance and service excellence.
The outcomes of the Accreditation Report have been used to develop the LTC Branch quality improvement activities for 2010 to 2013, and are reviewed by the various Branch committees to ensure that ongoing quality improvement and service excellence is based on national standards.
Steve Kanellakos
Deputy City Manager, City Operations