RECAP: Standards & Quality - The Future of Care in Community
Caring is in a state of evolution. New technologies, the increasing complexity of clients, and the growing importance of accessing quality care in the community and at home demands imaginative solutions and new ways of working. While we look to the future of care in the community, it is critical that every part of the sector remains grounded in the people we serve, the places we call home, and in the science, stories and experiences that inform our practice.
This article features the opinions of our three panelists in last month's webinar about The Future of Care in Community. Below you’ll find their answers to some of our questions about Standards & Quality.
Anne Whelan
I'll start at that macro level and say I had the privilege a number of years ago to sit on the group that developed the standards for Accreditation Canada, which has become the Qmentum Program. I learned a lot from there about that systems-level approach to quality. Now I sit on the CSA Group Board of Directors.
Right now, CSA and the Health Standards Organization (HSO) are working together on a set of new standards, particular to long-term care. Governments of all levels are very involved in that and very concerned about quality - not just from a service delivery standpoint (e.g. staff training, employee wellness, client outcomes, etc.) but also what the physical spaces and buildings are like and how critical processes perform. This ranges across discharge and intake processes, what diversity and inclusion looks like for residential care and so on. There's a really heightened focus on that which will drive change in the sector moving forward.
Some of this has been somewhat reactive to COVID, where we saw the disease do the most harm to Canadians in long-term care. There are broader reflections as well with regards to how regulatory bodies look at what they're funding and how those services are being delivered and what outcomes are being achieved. I think overall, we are going to see higher expectations (and rightly so) for how organizations deliver services across the board inclusive of government-operated, privately-operated and non-profit facilities.
A key point here is that asking and expecting more, requires a greater investment by governments. That's always a challenge for organizations in the community care sector, which is all too often the poor cousin of the healthcare system.
Looking at this from a grassroots perspective, our customers, our patients, our clients, their families, our employees, are asking for better quality: quality of work, quality of life, quality of care, quality of reporting, and quality of outcomes. The demand to have the right systems and processes at an organizational level in addition to good people doing good things, has kind of been a hallmark of the community care sector for a long time. Just as important now and looking ahead is being able to measure, manage, report and improve in systematic ways.
Peter Sproul
In Ontario, we’ve had what they called a Performance Measurement Framework, and it was an effort where they came up with a way to measure quality - in effect to identify outcomes that were indicators of quality and as a reflection back on program activity.
That hasn't ever really gotten out of the starting blocks in Ontario for various reasons. Part of it is COVID has hijacked all of our focus, but it is exciting to see these efforts back on again.
Historically, when you look at developmental services, we have focused on outputs and not outcomes. When you look at oversight for our organization and others in developmental services, the accountability is typically on measures of volume: how many people did you serve, how many were placed, how quickly were vacancies filled.
I'll give you an example of the difference between a measure of volume and a measure of quality: employment supports. What did we report on? How many people found and secured and maintained employment - competitive employment? Which is an important measure, don't get me wrong. But is that a measure of quality? I don't think so. Because there are a lot of lousy jobs out there. There are jobs that people can get placed into where they are alienated, they are bullied, they're marginalized. It is lousy work and lousy hours, and they're unhappy in that job. Again, there's a lot of great stories as well, right?
The point being, are we really measuring quality when we measure outputs, or when we measure volume? No, we're not. So we're shifting now to trying to have a framework to guide a shared understanding of quality. It might be an accreditation framework, or it might be some other homegrown framework that looks at aligning the program goals and indicators with personal goals.
So the three parallel pillars I would point to for an organization to start down the road of truly measuring quality is: 1) the mission and values of the organization, 2) the things that are in the control of the organization with respect to program goals and indicators, and 3) the individuals goals that they have set through a personal planning process. Those three things should align and be coherent. The more they're coherent, the more we will be positioned to start measuring quality, because what we're working on as a staff team in a particular program is entirely consistent with what people want with respect to facilitating outcomes.
To tie it back to my original comment, the emphasis on quality, certainly in Ontario, is gaining a lot of steam. There are more and more organizations that are desperate to do that, knowing that that's what we're going to be held accountable for, as well we should. An important question to consider in all this is how do you do this without it becoming this sort of template activity that starts to lose its meaning because it gets swallowed up in administration, versus truly looking at a measure quality as precise as we can make it?
Laurie Syzmanski
We approach quality a little differently. We're dealing with children in a treatment facility, and there is no other facility like ours anywhere in Canada. Because we are donor driven, we have to raise all the funds to support our program.
For us, quality of service is the difference that our programs are making for the children. We're only seven and a half years into this treatment facility. We've always wanted the quality of service to be for the children, and so seeing a difference in them, seeing improvements in their quality of life - lesser depression, reduction in PTSD - that's how we measure quality.
Families are bringing their children to us after something horrible has happened to them, so how do we instill confidence in them? For us accreditation has been an important part of the answer.. We are fully accredited through the Canadian Accreditation Council, exceeding expectations of the accreditation body. This has been so important to the families. We also embody our accreditation; we don't just say that we have it. We don’t have policies in a corner. We live these every day. We want to make sure that children are getting the best care that they can get, while supporting our staff.
Quality of service also comes back to making sure staff have the training they need. Not only are we managing and working with the children in a trauma-informed way, we're also supporting our staff in a trauma-informed way. Our whole organization has taken on being a trauma-informed organization. We feel that also raises our quality of service, to the children, to the staff, to our organization as a whole, and to our people who fund us, to know that we're doing the best that we can do.
Finally, our team also works with a scientific and clinical oversight committee. They evaluate all the data from the children. They ask the questions like: are we making a difference? And, can we prove that we're making a difference? So that's one of the things that we've included in our organization, which is using evidence-based programs and measuring the results of the kids as they move through the program.