Welcome to Cancer Care Ontario

1. Welcome to Cancer Care Ontario September 11, 2013 Garth Matheson CAPCA - COO Roundtable

2. We do more than Cancer now Core Competencies Performance Management and Management Cycle Access to Care Building on Ontario’s Wait Time Strategy Chronic Kidney Disease Ontario Renal Network launched June 2009; Cancer As mandated by the Cancer Act; Ontario Cancer Plan III Health System Policy Expertise Driving performance and quality Standards and Guidelines Public Reporting and Transparency Clinical Engagement and Alignment Regional Partnerships IM/IT

3. 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

4. New Corporate-wide Areas of Focus Patient-Centred Care Prevention of Chronic Disease Integrated Care Value for Money Knowledge Sharing & Support

5. Organizational Structure Board of Directors Audit and Finance Committee President and CEO Vice President, Ontario Renal Network Vice President, Chief Financial Officer Vice President, Planning and Regional Programs Vice President, Prevention and Cancer Control Vice President, Clinical Programs and Quality Initiatives Vice President, Corporate Services, General Counsel and Chief Privacy Officer 14 Regional Vice Presidents Vice President, Communications Vice President, CIO

6. 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

7. Cancer Survival in Ontario

8. 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 • Continue to asses and improve the patient experience 4 5 • Develop and Implement innovative models of care delivery • Expand our efforts in personalized medicine 6 The System Strategic Plan 8 www.cancercare.on.ca

9. CCO does not operate facilities or deliver care • 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

10. The Performance Structures

11. 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 • Prevention • Family Medicine • Screening • Cancer Imaging • Pathology and Laboratory Medicine • Surgical Oncology • Systemic Treatment • Radiation Therapy • Psychosocial Oncology • Patient Education • Survivorship • Palliative Care Regional Cancer Programs led by Regional Vice Presidents Provincial Clinical Programs with Clinical Leads Other regional cancer providers (e.g., home care, hospice, etc.)

12. The performance improvement cycleUsing key levers to improve the system Identifying quality improvement opportunities Monitoring performance Horizon-scanning and championing innovation Developing and implementing improvement strategies Standardizing development and guidelines

13. 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

14. 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

15. Considers the full Cancer continuum Prevention Goes to Routine screening Family doctor/ health centre Referred to Referred to Hosp or SMRCC to undergo tests Cancer not diagnosed Diagnosis of cancer Surgery Palliative/Supportive care Radiation Systemic Continuing treatment End of treatment Long-term monitoring and follow up Relapse Terminal care Death Cure Survivorship

16. Example of a priority indicatorSystemic Treatment – Referral to Consult (RCC) Shows relative position against target and change from previous period - one target for all - Confidence intervals - Rank order

17. From indicators to motivating performance in the FieldHow do we do it without line authority?

18. Motivate through passion for the cause -a growing demand for care It is estimated that and 45% of males will develop cancer in their lifetime 40% of females Incidence + Prevalence Chronic Disease

19. Motivate with credibility - clinical engagement throughout

20. Motivate through formal structures for accountability Administrative and Clinical Leadership

21. 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

22. Motivate through regional participation - the RCP Cancer Centre Hospital Academic Centres PHUs Research Prevention patients & clients Palliative Care Screening CCACs Physicians Supportive Care Acute Care Other Health Care Providers 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. An alliance is formed.

23. Motivate with data -comparative reporting

24. Motivate through healthy competition -overall ranking of RCPs Z Score Ranking: relative distance between the centres

25. Critical Success Factors

26. Strong policy and planning capacity

27. 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

28. A must… a strong IT/IM backboneInformation Strategy Framework • Innovation • Informatics • Instrument the System • Infrastructure

29. Monitoring tools Regional Cancer Scorecard

30. 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

31. Culture of public reporting on performance • MOHLTC Wait Times site • Cancer System Quality Index (CSQI) • CCO Web site

32. A watch-dog - CSQI 2012 summary Cancer Quality Council of Ontario

33. A must…many partnerships Health care providers

34. A must…infrastructure/capacity

35. A must…good leaders who are: • Passionate • Creative • Change agents • Influencers • Motivators • Thinkers • Etc. • dissatisfied with current performance • performance managers, not performance reporters

36. 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

37. 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

38. So Much More to do