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Quality Improvement Projects

Within healthcare settings, change can be challenging. It requires integrated and comprehensive evaluation of a given concern and a project management lens to envision and enact solutions. This can be a daunting undertaking in the shadow of delivering care, which may lead to stagnation within an organization and their services. Quality improvement is the process in which positive changes to yield stronger care outcomes can be achieved. It involves understanding a problem, including what contributes to it and the impact of it. This understanding informs potential changes and evaluation of barriers to implementing these solutions. Ultimately the goal of quality improvement is to successfully change a process wherein the change supports the strength of the intended outcome measure.

LTHC is well versed in coordinating and managing the quality improvement process. Our consultants utilize industry-standard LEAN project management methodology to efficiently guide your team through the methodical process of quality improvement. We have supported Emergency Department hospital teams in collaborating to identify areas for change to improve patient flow by organizing and facilitating stakeholder consultations. This process further allowed the LTHC team to guide solution development and implementation wherein we identified procedures that could be made more efficient in the patient journey. Finally we ensured sustainability of this improvement by conducting fulsome outcome measures and stakeholder engagement.

Accreditation

Accreditation allows organizations to ensure care standards are being met, and communicate to service beneficiaries that certain parameters have been assured. Organizations bearing accreditation status can attest that their policies and procedures are of a specific standard that are vetted by the third-party accreditor. This supports informed decision making for the public, and capacity for an organization to ensure high quality standards are being met. Accreditation requires extensive, rigorous auditing and assessment of an organization’s policies and how they are adhered to in delivering services, which are compared to evidence-based standards set out by the accreditation body. Successfully accredited organizations are able to communicate their commitment to delivering consistent quality in service of continuous improvement.

At LTHC, our consultants have supported organizations in preparing for the accreditation process. The expertise brought by our consultants ensure a seamless understanding of the process to set realistic expectations and provide guidance throughout. By conducting internal policy reviews and procedure assessments, we are able to support stakeholders in increasing their likelihood of achieving high-level accreditation statuses. Previously our consultants have worked with mental health organizations to develop a host of new policies aligned with the Commission of Rehabilitation Facilities standards which allowed them to achieve long-standing accreditation status. Our services efficiently enable your team to approach accreditation with confidence, organization, and ease.

Cancer Screening Development

Current data indicates that 1 in 2 Ontarians will develop cancer in their lifetime, and approximately 1 in 4 are expected to die from the disease. This statistic underscores the critical role of primary care in ensuring effective screening programs that facilitate early diagnosis and intervention. The COVID-19 pandemic forced Ontario to suspend or limit non-urgent healthcare services, including cancer screening. Although efforts have been made to recover from the disruption of cancer screening services during the pandemic, gaps in access to screening persist, particularly among people living in neighborhoods with higher levels of material deprivation and ethnic concentration. This emphasizes the need to prioritize equity in cancer screening (Ontario Cancer Screening Performance Report 2023).

LTHC consultants co-developed a Cancer Screening program within a primary care organization and increased patient participation in screening significantly by:

– Creating a system that accurately identifies patients who are eligible for Breast, Cervical, and/or Colorectal cancer screening
– Using an evidence-based script to contact eligible patients by phone to notify them about their screening status, educating them about the importance of cancer screening, and facilitating their screening appointment with the appropriate provider
– Developed a dashboard that tracked and displayed cancer screening rate improvements overtime per patient roster since the implementation of the program

Equity, Diversity, Inclusion

Equity, Diversity, and Inclusion (EDI) have become a key focus for healthcare organizations and leaders. Increasing socioeconomic challenges, along with persistent health disparities across the social gradient, have prompted healthcare practitioners, leaders, and researchers to explore how the healthcare system can help ensure that everyone has the opportunity to achieve good health.

Equity, Diversity, and Inclusion can be defined as (Source):

Equity: Where everyone is treated according to their diverse needs in a way that enables all people to participate, perform, and engage to the same extent.

Health Equity: Removing institutional and discriminatory barriers that lead to health inequities and inequality. This includes factors within the healthcare system, such as racism and sexism, as well as factors outside the healthcare system, such as poverty and unequal distribution of resources.

Diversity: The variety of unique dimensions, qualities, and characteristics we all possess, and the mix that occurs in any group of people. Race, ethnicity, age, gender, sexual orientation, religious beliefs, economic status, physical abilities, life experiences, and other perspectives can make up individual diversity. In the medical community, diversity often refers to the inclusion of healthcare professionals, trainees, educators, researchers, and patients of varied race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, and geographic region.

Inclusion: Creating a culture that embraces, respects, accepts, and values diversity. It is a mindful and equitable effort to meet individual needs so everyone feels valued, respected, and able to contribute to their fullest potential. Where diversity occurs naturally, creating the mix in the organization, inclusion is the choice that helps the mix work well together.

Inclusion means giving associates and patients from all backgrounds a voice in providing and receiving high-quality care. This act starts with encouraging a diverse healthcare staff to participate in the patient experience.

LTHC Consultants collaborated with a primary care organization to advance Equity, Diversity, and Inclusion (EDI) through the following initiatives:

– Established an Equity, Diversity, and Inclusion committee with a Terms of Reference to guide its activities.
– Developed a Health Equity survey to collect sociodemographic data from patients.
– Integrated EDI into the organization’s renewed strategic plan.
– Created and implemented a Safer Spaces checklist to ensure a welcoming and supportive environment for members of the 2SLGBTQ+ community looking to access care.
– Launched organizational initiatives to recognize cultural observances, celebrate diversity, and provide educational opportunities to staff (e.g., Black History Month, Truth & Reconciliation Week, Eid, etc.).

Service Expansion

Ontario continues to experience rapid population growth, driven by newcomers seeking a happy and prosperous life for themselves and their families. Simultaneously, the province’s population is aging and socioeconomic challenges such as housing and food insecurity, stagnant wage growth, and inflation continue to impact health. Healthcare organizations and systems must be able to respond to the demands placed upon them in an efficient manner. A key aspect of this is ensuring that healthcare programs and services are designed to effectively meet the needs of the communities they serve.

LTHC consultants supported a primary care organization in planning a major expansion of its core health services to better serve the rapidly growing areas of their community. To prepare for this service expansion, LTHC consultants conducted a community needs assessment that involved:

– Accessing data from regional database repositories to determine key demographic and socioeconomic indicators of the service expansion area by postal code, including age, sex, household income, ethnicity, languages spoken, and immigration status.
– Community asset mapping, including stakeholder engagement with key health and social service sector organizations to gain knowledge about the service expansion area and exploring areas of collaboration to ensure optimal use of resources
– Developing and administering a health needs survey to community center visitors in the service expansion area, providing insights into the health service preferences and needs of residents.
– Requesting and analyzing data from the local hospital system that provided insight on the chief reasons why service expansion area residents visited the emergency department.
– In addition to survey data, hospital insights, and stakeholder engagement, a review of the literature and public health data was conducted to determine the primary healthcare needs of the population.

The findings were summarized in a report presented to senior leadership, offering recommendations for service expansion. The stakeholder engagement process also helped establish new partnerships with community organizations.

Program Evaluation

LTHC has experience conducting primary care program evaluation to determine a program’s effectiveness, efficiency, and impact on patient/client outcomes. Key tools and methods used to conduct program evaluation include:

– Developing and implementing a comprehensive evaluation plan following Public Health Ontario’s 10-Step Evaluation Model
– Applying an equity lens by utilizing Ontario Health’s Equity, Inclusion, Diversity and Anti-Racism Framework as an evaluative tool
– Engaging stakeholders extensively through multi-stage knowledge synthesis, interpretation, and dissemination
– Conducting both qualitative and quantitative data analysis

LTHC consultants worked on the evaluation of a primary care program focused on the care of adults over the age of 65 living with one or more comorbidities. Patients enrolled in this program received wrap-around care from Family Doctors, Nurse Practitioners, Registered Nurses, Registered Pharmacists, Registered Dietitians, and Registered Social Workers. In addition to receiving care from providers involved with the program, patients requiring higher-level care due their prognosis are referred to specialty clinics located in the community or local hospital system. After the evaluation was completed, a detailed report was developed that outlined key findings, incorporated stakeholder feedback and experiences, analyzed both qualitative and quantitative program data, and offered recommendations to address the most critical gaps in the program. The report also included an action plan for implementing these recommendations.

Clinic Operations

Operating a medical clinic involves managing a variety of essential components to ensure smooth functioning, high-quality patient care, and regulatory compliance. LTHC consultants managed and operated a COVID-19 Clinical Assessment Clinic from the onset and throughout the peak times of the COVID-19 pandemic. During this time, the clinic conducted:

– 15,000 clinical assessments from a Physician and Nurse
– 15,000 COVID-19 tests
– 10,000 COVID-19 vaccinations

Key elements of operating a clinic include:

Facility Management:

– Location and Space: Securing and designing a suitable location that is accessible to patients. This includes ensuring the clinic has adequate space for patient rooms, waiting areas, administrative space, and specialized rooms (e.g., labs, procedure rooms).
– Equipment and Supplies: Procuring and maintaining medical equipment (e.g., examination tables, diagnostic tools, computers) as well as ensuring a consistent supply of medical materials (e.g., bandages, syringes, medications).

Staffing:

– Medical Professionals: Hiring qualified healthcare providers, such as physicians, nurse practitioners, nurses, medical assistants, and specialists as needed based on the clinic’s services.
– Administrative Staff: Hiring administrative assistants to assist with medical record keeping, scheduling, referrals, and ensuring respectful communication when answering patient inquiries
– Support Staff: Custodial, maintenance, and IT staff to ensure the clinic remains operational, clean, and compliant with health and safety standards.

Financial Management:

– Budgeting and Financial Planning: Developing a budget to cover operating costs, including salaries, utilities, rent, equipment, and supplies. This involves planning for financial sustainability.
– Billing and Revenue Cycle Management: Handling patient billing, processing insurance claims, and managing accounts receivable/payable.
– Pricing Strategy: Setting fees for services that are competitive yet sustainable.

Patient Care and Clinical Operations:

– Appointment Scheduling: Establishing an efficient system for booking appointments, managing patient flow, and minimizing wait times. This includes integrating online booking systems if available.
– Clinical Protocols: Implementing standardized clinical workflows, such as triage, patient assessments, diagnostics, treatment plans, follow-up care, and emergency response protocols to ensure high-quality and consistent patient care.
– Quality Improvement Programs: Implementing systems to monitor patient outcomes, identify areas for improvement, and ensure continuous quality enhancement in both clinical and administrative practices.

Market & Costing Analysis

A market and costing analysis is a comprehensive evaluation that helps organizations understand both the market dynamics and the financial implications of a project, product, or service.

In the healthcare field, a market and costing analysis can take different forms depending on whether the venture is funded through public funds (e.g., government programs, grants, or non-profit entities) or private investment (e.g., personal investment, private equity, venture capital, or commercial financing). This distinction influences the approach to both the market and costing analysis due to differences in objectives, stakeholders, and financial expectations.

Market Analysis:

A market analysis assesses the market conditions related to a particular product, service, or idea. It aims to identify:

– Market size and demand: The potential client base, how large it is, and how much demand exists for the product or service.
– Target audience: The specific group of clients the product or service is intended for, based on demographics, behaviours, and needs.
– Market trends: Current and future trends that could impact the product or service, including technological advancements, regulatory changes, and shifts in client preferences.
– Competitor analysis: Evaluation of direct and indirect competitors, their strengths and weaknesses, market share, pricing strategies, and positioning.
– Barriers to entry: Obstacles that could make it difficult to enter or succeed in the market, such as high start-up costs, regulatory requirements, or established competition.
– Market opportunities: Identification of gaps or unmet needs in the market that the organisation could capitalise on.

Costing Analysis:

A costing analysis focuses on understanding the financial aspects and cost structure of the project, product, or service. It includes:

– Fixed costs: Costs that do not vary with production/service levels, such as rent, salaries, and equipment.
– Variable costs: Costs that change with the level of production or service usage, such as materials, labour, and shipping.
– Cost of goods sold (COGS): The direct costs associated with producing the product or service, including raw materials and labour.
– Break-even analysis: Identifying the point at which revenue covers all costs, determining how much needs to be sold to avoid losses.
– Profit margins: Assessing the profitability of the product or service by calculating the difference between sales revenue and costs.
– Pricing strategy: Determining the optimal pricing based on costs, competition, and customer willingness to pay.

Together, a market and costing analysis provides valuable insights into the viability and profitability of a venture. It informs decision-making on whether the market conditions are favourable and whether the costs align with financial goals.

LTHC consultants conducted a market and costing analysis for Anamav Postnatal Care. Anamav offers some of the most essential services that a new mother needs: an extra set of hands, someone to offer words of comfort or just listen, and lactation support for those who choose to and are able to breastfeed. Anamav is on a mission to provide a safe, nourishing environment for parents who have just had a baby, and to provide support and education so that they have a stronger foundation. Currently, Anamav is providing their services in the home of their clients, however, they have a bold vision to open up a postnatal care centre where families can access all the support they need, 24 hours a day.

Feasibility Study

Healthcare leaders, organizations, and innovators are constantly coming up with new ideas to provide safer, higher quality care to patients and clients. A feasibility study is an analysis conducted to assess the practicality and potential success of a proposed project or idea. It evaluates various factors, including technical, financial, legal, and operational aspects, to determine whether the project is viable and worth pursuing. The goal of a feasibility study is to identify potential challenges, risks, and benefits, and to provide decision-makers with the information needed to make informed choices. The study typically covers:

Technical feasibility: Can the project be executed with available technology and resources?
Financial feasibility: Will the project be cost-effective and financially viable?
Legal feasibility: Are there legal or regulatory issues that could affect the project?
Operational feasibility: Can the organization implement and manage the project effectively?
Schedule feasibility: Can the project be completed within the proposed timeline?

A healthcare feasibility study must also determine whether the proposed idea is grounded in evidence-based practices, meaning it should be supported by current research, clinical trials, or proven methodologies that demonstrate its effectiveness. Additionally, it is essential to assess whether the idea complies with ethical standards, ensuring that it respects patient rights, maintains confidentiality, and prioritizes informed consent. Safety is another critical aspect; the study should evaluate potential risks to patients, healthcare providers, and the broader community, and ensure that appropriate safeguards and protocols are in place to mitigate harm and promote overall well-being.

LTHC consultants conducted a feasibility study for Anamav Postnatal Care. Anamav offers some of the most essential services that a new mother needs: an extra set of hands, someone to offer words of comfort or just listen, and lactation support for those who choose to and are able to breastfeed. Anamav is on a mission to provide a safe, nourishing environment for parents who have just had a baby, and to provide support and education so that they have a stronger foundation. Currently, Anamav is providing their services in the home of their clients, however, they have a bold vision to open up a postnatal care centre where families can access all the support they need, 24 hours a day.

Salmaan Lodhi

Managing Director

Email: [email protected]

Salmaan holds a Bachelor of Science in Psychology, Neuroscience, and Behavior alongside a Master of Business Administration from McMaster University. His career has focused on project management and optimization at various levels of healthcare.

Salmaan’s work experience in case management, primary care, hospital settings, and governing bodies have equipped him with expertise in healthcare delivery at all levels. Some key projects include organizational accreditation preparation and policy review, hospital service delivery optimization through a complete process assessment and redesign using LEAN methodology, and establishing and operating new healthcare clinics. This has supported the acquisition of his PMP designation, which allows him to support projects throughout their entire life cycle and create effective, impactful deliverables.

Salmaan welcomes endeavors around integrative healthcare, quality improvement, and optimization. He is passionate about delivering high quality health services that diminish health disparities and create equitable care opportunities for all.

Karan Tiwari

Managing Director

Email: [email protected]

Karan earned his Bachelors of Science in Kinesiology from the University of Waterloo, and is currently working on completing his MD. His educational journey was fueled by his passion for ensuring everybody receives the care and resources they need to contribute and thrive in a community. Having worked in hospitals and clinics throughout Canada and the USA, he has multiple years of clinical experience and has acquired an understanding of how different models of care are delivered.

Karan also has a keen interest in learning how to leverage new technologies and data for organizations to provide the best care possible for their community. This interest has coalesced into a role within an IT company that specializes in providing non-profit and health care organizations with IT solutions and support.

Rahul Tiwari

Managing Director

Email: [email protected]

Rahul has extensive experience working as a Project Manager in the healthcare field, with a focus on the Primary Care sector. He has worked collaboratively within interdisciplinary teams of healthcare professionals and with regional partners to deliver community-driven and evidence-based initiatives aimed at improving patient outcomes and experience, optimizing workplace processes, and supporting equity, diversity, inclusion, and accessibility.

Rahul is committed to using his experiences and skills to serve his community and to advocate for the structural changes that will allow people to lead healthy and happy lives. He is also passionate about expanding his clinical skillset, and is a certified Primary Care Paramedic with Toronto Paramedic Service. Rahul completed his Bachelor of Science in Kinesiology at the University of Waterloo, and then his Master of Public Health at McMaster University.

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