Appendix 2:
Terms of Reference for the Bay of Plenty Community Care Co-ordination Quality Improvement Team (BOPCCC QI Team) Definitions: BOP ALT
Bay of Plenty Alliance Leadership Team, established to provide oversight and enable activities to be progressed, as identified within the Scope of the Health Alliance (BOP) Alliance Agreement and with a membership that reflects the partnership between local Primary Health Organisations (PHOs), the Bay of Plenty District Health Board and its Provider Arm. BOPALT is the governance group for the establishment of the Bay of Plenty Community Care Coordination Demonstration Site Project.
BOPCCC
Bay of Plenty Community Care Co-ordination – a new service established as a demonstration for a wider strategic approach to care co-ordination as set out in the BOP Strategic Health Services Plan 2017-2027 and one of three implementation priorities for the Integrated Community Nursing Model of Care.
Purpose The purpose of the BOPCCC Quality Improvement Team is to champion and drive improvements in the BOP Community Care Co-ordination Demonstration Site and evaluate the effectiveness of the demonstration site in order to inform a decision about the future of the demonstration site and what changes may be needed for greater impact.
Background As one of three implementation priorities of the BOP Integrated Community Nursing Model of Care 3 and Implementation Plan4, the BOP Community Care Co-ordination service has been established as a demonstration site for 12 months commencing 1 March 2018.
3http://www.bopdhb.govt.nz/media/58212/an-integrated-model-of-care-for-community-nursing.pdf 4
http://www.bopdhb.govt.nz/media/60397/icn-service-description-and-implementationv2.pdf
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At its meeting on 12 July 2017 the BOPALT agreed to: 1.
‘Support the establishment of a demonstration site within Support Net as the single place for accessing information and community nursing services. The demonstration will take place over a 12 month period, anticipating a September 2017* start. The outcomes of the demonstration will be evaluated and will inform BOPALT in establishing a common position on the broader aspects of system-wide Community Care Co-ordination and the best options in the long term, noting the intention to expand the concept of centralised coordination to include other services.’
2.
The approach was agreed to on the basis that it ‘allows for testing in a safe, controlled environment’. The aim was also for this option to lead to the kind of change that transcends current practice. To mitigate the risk of the status quo being maintained it was proposed and agreed that Alliance partners have input into the demonstration and develop and jointly agree evaluation measures. * Later changed to 1 March 2018 Objectives and scope BOPCCC The objectives and scope of the BOPCCC are set out in the detailed service description and implementation plan for the Integrated Community Nursing Model of Care, and the BOPCCC project implementation plan. The initial aim and scope of BOPCCC is for 100% of referrals for community nursing services to be managed by the service, operating 7 days a week in order to: 1. Improve access to community nursing care; and 2. Be a place for referrers, patients, families and whanau to access care information. The scope of the demonstration site includes: • Referral management including screening, triaging and prioritising; •
Determining the right care setting;
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Allocation of referrals to appropriate service providers; and
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Provision of relevant information to key stakeholders (includes establishing and maintaining an 0800 number and service directory).
Term The QI Team will commence on 1 August 2018 and will end on or before the 30 June 2019. The term is likely to be extended by mutual agreement of the BOPALT if necessary to complete the project.
Governance
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BOPALT is the governance group for the establishment of the Bay of Plenty Community Care Coordination Demonstration Site Project.
Quality Improvement methodology The QI Team will adopt and apply the Institute for Healthcare Improvement Model for Improvement as the change/improvement methodology.
Scope The scope of the work to be undertaken by the BOPCCC QI Team is all activities associated with reviewing and evaluating performance data for BOPCCC, identify and plan for improvements for the demonstration site; champion for and monitor improvement efforts; identify and report any risks to the success of the project to BOPALT. The key deliverables of the QI team are: a. Review and refresh the BOPCCC Project Plan b. Apply rapid evaluation and improvement techniques using the Institute for Healthcare Model for Improvement. c. Support the Operations Manager and management team to operationalise improvements d. Review and enhance the performance measures e. Develop a template for reporting that aligns with the Model for Improvement f. Review performance data and assess the effectiveness of the initiative to date against the project plan. g. Provide advice and leadership to support change management and improvement initiatives. h. Ensure linkages and integration with other Strategic Health Services Plan projects i. Assess the feasibility of ideas for expansion of the scope and suite of services managed by the BOPCCC team and make recommendations to BOPALT. j. Seek BOPALT decision/direction on identified risks to achieving goals. k. Work with key stakeholders to develop systemic solutions to resolving issues (for example resolution process if a referral pathway is contested or brought into question). l. Identify resource requirements and contribute towards submissions to the Funding Management Committee of the DHB and/or BOPALT. m. Champion an integrated and whole of system way of working n. Develop recommendations for BOPALT to inform a decision about the whether the demonstration will move beyond the test phase to full implementation, and if so, what changes may be needed for greater impact. Recommendations to be submitted to the BOPALT meeting on 24 October 2018 to allow time for changes to be implemented prior to the end of the demonstration site on 3 March 2019.
Membership: Membership of the QI Team will reflect system leadership, clinical/technical expertise and operational leadership and be comprised of the following roles: • •
Customer/patient advisor Operations Manager, BOPCCC
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• • • • • • • •
Maori Health Equity Advisor Planning and Funding Portfolio Manager Primary care Nursing Leadership Secondary Care Nursing Leadership Business Analyst Expert/Technical advice in Community Care Co-ordination Project Co-ordinator Improvement Advisor
Consideration could also be given to including members with knowledge and experience of care coordination initiatives elsewhere in NZ or internationally. Planning and Funding will provide project coordination, secretariat support, draft agreed communications (with support from the DHB Communications team) and project reports etc.
Chair The Chair will be nominated by the QI team and endorsed by the BOPALT. Co-opted Members The QI team will identify other members who are appropriate for co-opting for specific work stream activities and will recommend these to the BOPALT as the project progresses. A meeting quorum will consist of at least 5 members (including 2 each from BOPDHB and Primary Care).
Members’ attributes and personal requirements Desirable attributes for members are that they will support the success of the initiative; enhance the learning of the existing team; foster a collaborative, whole-of-system approach; and support best practice in improving Maori health and reducing inequalities. Consideration could also be given to including members with knowledge and experience implementing similar care co-ordination initiatives elsewhere in NZ. The following personal attributes are desired of members: • Alignment with CARE Values •
Knowledge and experience in reducing inequity and improving Maori Health
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Experience in quality improvement
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Knowledge of and/or experience of front-line service delivery
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Respected by their peers
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Competent operators
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Strategic thinkers
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Flexible and responsive
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•
Have operational expertise
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Have a broad health systems focus
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Open to new ideas
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Clinical and support service experience
Membership Process 1. Membership will be nominated and endorsed by the BOPALT, ensuring: 2. Nominations are sought for membership from services that are funded by BOPDHB 3. The majority of members have relevant clinical experience and knowledge of the BOP district and primary, secondary and community care providers. 4. Expertise can be co-opted as appropriate for specific work streams and as agreed by the QI Team and/or BOPALT. 5. In the event that nominations for positions exceed the number required, BOPALT will determine formal appointments. In the event that there are not enough nominations for positions, Planning and Funding will support BOPALT to identify and approach potential appointees 6. Vacancies will be filled as and when required 7. A Chairperson will be elected/appointed from within the appointed membership and endorsed by BOPALT 8. Membership (unless reappointed) will continue until: a. A member resigns (in writing) giving one months’ notice. b. 30 June 2019 or the completion of the project, whichever is the earlier.
Conflict of Interest Members of the group will identify and document their conflicts of interests on appointment to the QI Team. If a member has an interest relating to specific agenda items at any given time, then that should be declared at the start of the meeting or discussion on that agenda item. The QI Team will adopt strategies as appropriate to ensure those conflicts are effectively managed. Code of Conduct The project will: • Be conducted in an environment of open communication and mutual respect. •
Take a collaborative approach that uses consensus decision making to promote group accountability and positive relationships.
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Operate a transparent process open to scrutiny.
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Ensure that full engagement with majority support from health providers underpins any recommendations for change to existing arrangements and obligations.
Meeting Frequency The QI team will meet at least fortnightly but may vary depending on the progress of the project and the activities engaged in at any given time. Meetings will be face-to-face. Video conference or other suitable mechanisms may be agreed within the QI team.
Communication 1. Members will not communicate with the media about business of the project. 2. Formal communication from the project will be managed by the Chair of BOPALT, including any communications with stakeholder groups. The Chair can delegate this responsibility to a nominee as appropriate. 3. The project team will communicate with BOPALT through the General Managers, Planning and Funding, ensuring progress updates are provided in a timely manner. 4. Members are able to discuss agreed topics relating to the work of the project with their colleagues in order to assist the member to provide specific advice to the group, except where items have been identified to remain in committee. 5. The QI team will prepare regular updates for stakeholders to ensure a transparent process and consistent messages are communicated. 6. In general any project papers, updates or reports will be distributed only to BOPALT in the first instance.
Disputes Resolution Disputes or disagreements between members that are not resolved to the satisfaction of all parties through group discussion will be referred to BOPALT in the first instance, ensuring that respective views, opinions and areas of disagreement are reflected. BOPALT shall determine agreed a way forward within the constraints of available resources and provider support as required.
Exclusions The QI Team is not responsible for directly implementing actions within the Project Plan as this will be the responsibility of the Operations Manager and BOPCCC Service team.
Terms of Reference Review These terms of reference will be reviewed within the first 3 meetings of the QI project team. Any recommendations for change will be submitted to BOPALT for consideration and adoption as appropriate.
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