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Building a Strategy Map and Scorecard for Community Mental Health A partnership with the Mental Health and Addiction Branch and the Health Results Team-Information Management Sept 19, 2006. Presentation Outline. The Mental Health System Strategy Map Issues abstraction and categorization

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  1. Building a Strategy Map and Scorecard for Community Mental HealthA partnership with the Mental Health and Addiction Branch and the Health Results Team-Information ManagementSept 19, 2006

  2. Presentation Outline... • The Mental Health System Strategy Map • Issues abstraction and categorization • Identifying dimensions (goals) and sub-dimensions (objectives) of performance • Developing the mental health system strategy map • Next Steps - The Scorecard • Identifying and confirming indicators. • Identifying measures • Creating a mental health system scorecard.

  3. The Mental Health Strategy Map • MHAB has partnered with HRT-IM to develop a mental health strategy map. A scorecard is next step. • Steps/Tasks undertaken: • Issues abstraction - background materials and issues identification • Categorization of issues • Identification of broad Dimensions (Goals) and Sub-Dimensions (Objectives) of Performance • Development of draft Strategy Map. • Review and Approval of Strategy Map - MHICAC and Mental Health and Addiction Branch management team

  4. Increase access to key health care services Improve patient-centredness, integration & quality of health services Increase availability of high quality, relevant evidence Increase access to & uptake of evidence for decision-making and accountability Increase productive use & appropriate allocation of resources across the system Improve clinical outcomes Improve healthy behaviours, health promotion & disease prevention Improve health status • Health System Strategy Map • 9 strategic themes, synthesized from: • Information contained in Ministry plans and other documents • Similar work done elsewhere (e.g. CQCO) • What is known about current health system continuous improvement objectives • Themes represent loci of strategic action, and provide the framework for selecting performance indicators • Arrows represent hypothesized relationships among strategic themes, and together, depicts how the health system creates value Increase sustainability & equity of the health system The Health System Strategy Map…To review Work in Progress

  5. Increase access to key health care services Improve patient-centredness, integration & quality of health services Increase availability of high quality, relevant evidence Increase access to & uptake of evidence for decision-making and accountability Increase productive use & appropriate allocation of resources across the system Improve clinical outcomes Improve healthy behaviours, health promotion & disease prevention Improve health status Increase sustainability & equity of the health system Turning the Health System Strategy Map in to a Scorecard 2. Provision of Care 1. Evidence Availability and Use 3. Health Status & Outcomes The four boxes in this diagram evolve into the four quadrants of the Ontario Health System Scorecard 4. Sustainability & Equity The task now is to develop a Mental Health System Strategy Map... Work in Progress

  6. Mental Health Strategy Map/Scorecard Development Principles • Build on existing work as much as possible • A great deal of work, inside and outside the ministry has already been done that can help with this initiative. Stakeholders (and staff) resent having previous work shelved, only to be duplicated by new work. • Use the data/information we currently have on-going, reliable access to. • Measure what we can and learn from the gaps. • View this as a starting point, a work in progress, and a learning tool. • The Strategy Map/Scorecard may not be perfect the first time. In it’s first iteration, it may not adequately address the complexities of the mental health system. If we view it as an on-going learning process, each iteration will get better and more sophisticated.

  7. Step 1 - Revisit Vision / Mission Making it Happen is current MOHLTC policy document for mental health (Principles reiterated in Mental Health Accountability Framework) Principles: Consumer at centre of system Services tailored to needs, view to increasing quality of life Consumer choice, streamlining access Services linked and coordinated - continuum Services based on best practices Safeguard funding Continued investments/reinvestments in community mental health Step 2 - Issues Abstraction Documents Reviewed Centre for Addiction and Mental Health (CAMH) Submission to the Standing Senate Committee on Social Affairs, Science and Technology, Oct. 2005 (i.e. Kirby) Consumer Survivor Initiatives: Input, Outcomes, Effectiveness A Strong Provincial Focus for the Addictions and Mental Health Sector in Ontario, July 2005. Joint position paper from: Canadian Mental Health Association – Ontario Division, Ontario Federation of Mental Health and Addiction Programs, Centre for Mental Health and Addiction. The Future Begins Now: Three Priorities for Mental Health Reform, Dec. 2002, Canadian Mental Health Association-Ontario Division. Outcomes and Effectiveness: The Success of Community Mental Health and Addiction Programs, 2003 Ontario federation of Community Mental Health and Addiction Programs Making a Difference: Ontario’s Community Mental Health Evaluation Initiative (CMHEI) - Longitudinal Study Mental Health Services in Ontario: How well is the province meeting the needs of person’s with mental illness? (CAP – Community Assessment Projects) Advice to the Minister on Building a Community Mental Health System in Ontario, Feb 1999 – Health Services Restructuring Commission. Review of Best Practices in Mental Health Reform Mental Health Implementation Task Force Reports. Selected recent District Health Council reports (i.e. reports focused on mental health prepared after 2003). Toward a Mental Health Strategy Map

  8. Toward a Mental Health Strategy Map • Issues abstraction process revealed the following broad themes: • Meeting consumer and family needs/choices • Best practices/quality of care/improved outcomes • Continuity of care • Access/service integration/coordination • Funding • System management/performance • Human resources • Themes are generally consistent with Making it Happen principles

  9. Toward a Mental Health Strategy Map Step 3 - Categorization of issues into dimensions (goals) and sub-dimensions (objectives) of performance Objectives • Ability to provide data/information • Quality/reliability of data/Information • Compliance of reporting Objectives: • Data that informs Policy, Program / system planning, Standards, Governance 1. Improve mental health data related to service delivery and to consumer need, utilization and outcome 2. Improve evidence-based decision making in the mental health system

  10. Toward a Mental Health Strategy Map 3. Ensure adequate supply and appropriate allocation of resources for mental health Objectives: • Equitably distribute resources • Appropriate funding for both clinical and non-clinical components. • Appropriate funding for consumer/peer/family supports. • Basket of services and an appropriate funding model is established. Objectives: • Increase availability of resources. • Mix of staff resources (including consumer/peer supports). • Distribution of staff resources. • Community-based agencies can compete with hospitals for staff resources. 4 A) Improve system capacity to deliver continuum of services and supports. 4 B) Increase availability of human resources (including peer supports)

  11. Toward a Mental Health Strategy Map 5. Improve coordination and integration of mental health services Objectives: • Reduce wait times for service • Availability of community services and supports • Coordination of intake, access, care among service providers • Reduced access/services barriers between sectors • Reduced access/services barriers for special populations (i.e. concurrent disorders, dual diagnosis, etc.) Objectives: • Continuity of care • Reduced systemic barriers to movement • Clear roles and responsibilities within and between system sectors 6. Increase access to mental health services 7. Improve consumer continuity of care

  12. Toward a Mental Health Strategy Map 8. Improve responsiveness of mental health system to needs of consumers Objectives • Range of services and supports • Consumers/family involvement in treatment decisions and program/system planning • Recovery as goal • Improve consumer satisfaction with services Objectives • Reduction in hospital admission, readmission, length of stay, ER utilization. • Diversion from and/or reduced involvement in Criminal Justice System • Increase in early intervention 9. Improve consumer choice and involvement in service planning and delivery. 10. Improve clinical outcomes 11. Reduce inappropriate utilization of hospitals and jails

  13. Toward a Mental Health Strategy Map 12. Improve social determinants of health outcomes Objectives • Improved Quality of Life (Housing, Employment, Social/Peer Networks, Income) • Improved functional status • Improved financial status • Improved Community Tenure • Reduction in Criminal Justice System Involvement Objectives • Community mental health services are equitably provided to all Ontarions • The community mental health system is sustainable over the long term. 13. Improve overall quality of life for consumers (satisfaction, well-being) 14. Ensure sustainability in the mental health system 15. Ensure equity in the mental health system

  14. Increase access to mental health services Improve clinical outcomes Reduce inappropriate utilization of hospitals and jails Improve mental health data related to service delivery and to consumer need, utilization and outcome Improve consumer continuity of care Improve evidence-based decision making in the mental health system A) Improve system capacity to deliver continuum of services and supports. B) Increase availability of human resources (including peer supports) Improve social determinants of health outcomes Improve responsiveness of mental health system to needs of consumers Ensure adequate supply and appropriate allocation of resources for mental health Improve overall quality of life for consumers (satisfaction, well-being) Improve consumer choice and involvement in service planning and delivery. Improve coordination and integration of mental health services Ensure sustainability in the mental health system Ensure equity in the mental health system Mental Health Strategy Map

  15. Next Steps…the Scorecard • A tool to articulate a mission and strategy (as illustrated in the strategy map) into a set of performance measures and targets - in this case, the performance of the mental health system. • The selected performance measures/indicators link to the strategic goals outlined in the strategy map. • The scorecard allows for more informed decision-making. • By linking the strategy map with the scorecard we develop an understanding of where action needs to be taken in order to improve performance and achieve desired outcomes. • By using similar frameworks for developing maps and scorecards, we can cascade them across the different sectors and levels of the health system, which will result in better strategic alignment throughout the whole of the health system. Ultimately leading to increased accountability.

  16. Toward a Scorecard for Mental Health Steps • Confirm strategy map with MOHLTC staff and management and with external stakeholders. • Develop framework for identifying performance indicators • From research and literature review; a review of what other jurisdictions are using; and, consultations with key informants develop a preliminary list of potential performance indicators. • Develop indicators technical manual - description of proposed indicators, supporting reference, how it’s measured, data source, data quality issues. • Review list of potential indicators with experts in the field (i.e. survey expert panel) to narrow down the list and select a small but powerful set of indicators for use with the scorecard (i.e. one or two indicators per goal). • Analyze feedback from survey and proceed into Phase 2 of indicators validation/confirmation process - In-person, facilitated workshop. • Populate and create first draft (test) scorecard using indicators selected/confirmed through the validation process. • Present scorecard V1, receive input and feedback and work on gaps and refinements for V2 Currently at Step 6

  17. Toward a Scorecard for Mental Health Just Completed Tasks • Initiate formal indicator selection,confirmation and validation process • Time-limited working group/expert panel • Identify experts for working group/panel (from research, acute care, community mental health, primary care,). 35 people identified for initial survey - will invite a smaller sub-group from these experts to participate in a workshop. • Develop survey instrument (use Survey Monkey) and workshop process • Analyze results of survey and review results and select indicators at facilitated workshop. Next Steps • Analyze survey results, confirm first set of indicators, populate scorecard. Timelines • Goal is to have a draft MH scorecard this fall

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