What was the opportunity?

CMHLG wanted to ensure they were effectively using their clinical time to meet the ever-growing needs of their community. They had experienced a recent increase in demand and clients were being impacted by longer wait times. A previously created target for direct services hours did not consider significant service coordination work and was not representative of the current landscape. The agency identified an opportunity to increase their understanding of not only what goes into direct service hours, but also all clinical hours, to become more efficient and better serve the needs of their clients.

What was the goal?

The team set out to create an accurate expectation for how clinicians spend their time (direct, indirect, other) and use the information to build efficiencies in how they serve their clients.

What were the improvements?

• Defined all the activities that make up a clinician’s workday and categorized them into direct service hours, indirect service hours, and agency functions.  

• Pilot-tested with a select group of clinicians to provide more insight into where most clinician hours are spent. This has since broadened to include more clinical staff for a longer period, to gather more accurate data.  

• Plans to streamline and standardize the processes to collect this information, so that the team can set reasonable and achievable targets and use the data to identify areas to create efficiencies. 

What was the impact?

Much of the work of the project implementation is still ongoing so the agency does not yet have data on improvements.

What was the opportunity?

FIREFLY observed that the majority of clients were experiencing lengthy wait times for counselling after receiving brief services. This led to inconsistencies in the client journey, which resulted in frequent changes in clinicians, clients retelling their stories multiple times, less therapeutic engagement, and client confusion. Clinicians also expressed frustration navigating the multiple pathways for themselves, as well as for clients and families. This issue was consistently reported by clients, families, clinicians, clinical managers, and community partners.

What was the goal?

The team set out to shorten the average wait time between brief services and counselling/therapy and to reduce the percentage of clients going on a waitlist. Additionally, they aimed to prioritize high-risk clients by appropriately rating severity at the initial assessment using a new screening tool. The goal was to increase overall client outcomes and satisfaction as well as shorten length of time in services. Over time, the team would like to eliminate any wait time between brief services and counselling/therapy for all clients.

What were the improvements?

What was the impact?

Much of the work of the project implementation is still in progress so the agency does not yet have complete data on the improvements. However, with the first set of improvements in the summer (primarily involving data clean-up), they observed a 20% decrease in their wait numbers. The team plans to replicate and spread their wins – particularly in communication and change management – across their agency.

What was the opportunity?

HANDs, the lead agency, in collaboration with Simcoe Muskoka Family Connexions (SMFC) and Community Counselling Centre of Nipissing (CCCNip), identified limitations in their data, the quality of their data infrastructure, standardized data processes, and human resource capacity. Insufficient data was evident in their client information system (EMHware) and other data sources. This resulted in increased effort and duplication when collating useful data for the core service table. Ultimately, these limitations restricted the depth and breadth of evidence available for the service agencies to make informed decisions on how to effectively meet the needs of their clients and communities.  

What was the goal?

The objective of this project was to standardize key performance indicators (KPIs) across the three agencies. The team ultimately focused on 10 KPIs from the Business Intelligence (BI) solution, developing a process that can be applied to standardizing future indicators, including aspects such as data definitions, data entry/extraction practices, and more. They also aimed to have a standardized location to store their data. The goal is to replicate this process until all KPIs from the BI solution are standardized. This will enable all three agencies to build and extract reliable and accurate data to support evidence-based decision-making and planning for their service area. The project also focused on improving data literacy and competency of staff within the agency.

What were the improvements?

• Developed a structured process for reviewing, selecting, operationalizing, and storing new KPIs and data.  

• Created a shared space on SharePoint to store data and other resources such as dashboards, past reports, and training material.  

• Improved data literacy and data capacity through consistent engagement and training efforts.

What was the impact?

Establishing a shared data space on SharePoint has streamlined access to local data, fostering collaborative efforts in decision-making. Simulation of extraction workflows and the data validation and analysis process were discovered through a pilot test of three indicators. Mock dashboards have been created and are being used as a communication tool to engage support from the leadership team.

Hands, SMFC, and CCCNip anticipate achieving a standardized set of KPIs as they replicate this process in the future. They plan to continue effective communication between all partners to facilitate buy-in. Once they have collected enough data, they plan to set short- and long-term targets and benchmarks to help inform decisions and future QI initiatives.

What was the opportunity?

Since the onset of the COVID pandemic, Keystone was seeing an increase in referrals for service and in the complexity of cases, while also experiencing staffing shortages. Families were wanting to have ongoing counselling service at intake; however, the demand for ongoing counselling services was higher than the agency’s capacity, due to staff turnover. As well, Keystone’s intake process was not fully streamlined, causing their waitlist to grow, as there was no definition or structure for their brief services and counselling services. In addition, there was an increase in no-shows, cancellations, and rebooking of appointments for brief services.  

What was the goal?

Keystone’s goal was to streamline and standardize the internal processes. They wanted to have clear definitions for walk-in, single session, and brief services that would be communicated amongst staff and partners, and with the community. They also wanted these definitions reflected in the client information system (EMHware) and on Keystone’s website. They aimed to meet ministry targets and client satisfaction for clinical services, and to decrease no-shows by having clearly defined and streamlined internal processes communicated across the organization.

What were the improvements?

• Delivered a single session therapy training for all clinical staff.  

• Established clear definitions, structure, language, and the pathway for services falling under the brief services umbrella.  

• Adopted a standardized screening tool at the first single session appointment.  

• Offered regularly scheduled psycho-education groups.  

• Designed a new client feedback survey.  

• Created policies, such as a discharge policy, to support brief service flow with clear time parameters and protocols.  

• Standardized improvements are reflected in the client information system (CIS) and communicated to staff, as well as to partners, and clients with an updated website. 

What was the impact?

The pathway for brief and ongoing counselling services at Keystone incorporates clinical insights to guide the journey and implement measures to prevent bottlenecking of clients. The improvements include a standardized definition of brief service that did not exist before, enhancing clarity for clients and staff. This standardized definition incorporates changes in language, aligning Keystone brief service and CIS terminology with Ontario Ministry of Health terminology.  

The team made discoveries related to the validity of their data, prompting Keystone to advocate for changes within EMHware to improve monitoring of their services.  

A new process of regularly collecting and incorporating client feedback was also developed and implemented, fostering Keystone’s commitment to a continuous improvement mindset.

What was the opportunity?

The Phoenix Centre recognized the need to improve the recruitment and retention of skilled and experienced family and child therapists. This challenge impacted their service delivery model, organizational reputation in the community, clinician well-being, and quality of services. Clients often expressed frustration regarding frequent changes of therapists and needing to "start over" when a transfer from an existing therapist to a new therapist occurred. 

What was the goal?

The goal of this project was to improve both the recruitment process and retention practices to decrease the number of therapist vacant positions and decrease their therapist turnover rate.

What were the improvements?

• Streamlined their recruitment strategy by introducing a pre-screening checklist and pre-interview questions to ensure only qualified applicants proceed to the interview phase.  

• Implemented PXT, a personality/job fit assessment, to match potential candidates against the performance model for the position. This tool also helps with coaching and onboarding by identifying specific areas of strength and weakness during the onboarding process for new therapists.  

• Addressed staff retention by implementing incentives such as dedicated team-building days and employee wellness days.  

• Incorporated work-life balance opportunities and challenges as part of their regular supervision to improve communication between therapists and their managers/supervisors. Further to this, they modified their supervision forms to address concerns with work-life balance and introduced “transparency time” to team meeting agendas.  

• Changed how cases were assigned to therapists, including brief therapy and intensive cases, to ensure a more balanced caseload and a more equitable distribution of evening sessions to improve access for children and families.  

• Implemented a new total compensation and reward project with guiding principles, decision-making process regarding compensation for hiring managers, and a competency-based compensation approach.

What was the impact?

The Phoenix Centre has seen a significant reduction in the time it takes from posting a job opening to completing interviews with selected candidates. Changes to their supervision template and team meeting agenda have fostered an environment of open and transparent communication, particularly in the areas of self-care and mutual support. They continue to monitor changes, such as the availability of evening appointments and the expectations regarding how those appointments are scheduled.  

What was the opportunity?

After implementing CAPA (Choice and Partnership Approach) at Woodview’s Brantford location, new challenges with intake began to emerge. Receiving referrals through multiple channels with an unclear internal process post-referral led to inconsistencies in the intake process. This resulted in confusion for families and service providers, inefficient use of time and resources, and internal staff inconsistencies. 

What was the goal?

The goal of this project was to improve the efficiency of the intake process by increasing the number of staff who find the process easy to understand, communicating better with families and service providers, and decreasing the number of steps in the process. The changes would be measured by overall satisfaction from staff, families, and referral sources.

What were the improvements?

What was the impact?

Though most data on the improvement results is still forthcoming, the project has had some positive impacts so far. Staff members now have a better understanding of the intake process. Feedback from referral sources, such as pediatricians, has been positive, citing improved clarity of the intake process and a better understanding of what services are available. Complaints from families concerning duplicate intake appointments have also decreased significantly.

What was the opportunity?

Boost CYAC identified that their client tracking and invoice process with service providers resulted in missed opportunities to engage clients with counselling and maximize allotted funding. Intake workers spent most of their time tracking down forms and invoices from service providers. These challenges stemmed from the process gaps in the Internet Child Exploitation (ICE) program, as well as the lack of a consistent process to document, report, and send invoices.  

What was the goal?

The goal was to improve the service flow and invoicing processes to alleviate daily inefficiencies and better serve ICE clients by tracking their use of funding and engagement with service providers. The aim was to identify clients who ended their therapeutic relationships early before maximizing their allotted funding.

What were the improvements?

• Revised program materials to be more concise, including the approval letter, invoice form, and registration package for the ICE program.  

• Revised related policies to identify accountabilities, to increase frequency of regular updates of the service provider list, and to provide clear guidelines for payment.  

• Provided more frequent orientations/refreshers (quarterly) for service providers, updates to their invoicing system, and a reconciliation process with defined timelines and processes to follow-up and close files. 

What was the impact?

It is hoped that the enhanced processes will ensure that better matches are made between clients and service providers, that client records are up-to-date, accurate, and appropriate, and that a follow-up with clients who end their counselling sessions early is completed. The enhanced tracking and follow-up mechanisms put in place will see a percentage increase in clients accessing therapeutic services in a timely way, engaging fully in the therapeutic process, and maximizing their allotted funds. 

What was the opportunity?

Hands observed challenges in their client brief services, as they did not have a formalized tool to assess the specific mental health needs of their clients. This made it difficult to identify a consistent care pathway option. As a result, clients were placed on a long waitlist for generalized counselling services, with minimal oversight and limited interactions. This often led to a need for re-assessments and redefining treatment goals if clients’ circumstances changed during the waiting period for services. This subsequently impacted the overall quality of services.   

What was the goal?

Their goal was to develop recommendations to implement needs-driven assessments and planning processes. To achieve this, Hands aimed to incorporate clear eligibility, exclusion, and priority criteria to define the pathways for waitlists categorized by specific interventions. They also aimed to focus on strategies for waitlist management and triaging recommendations that will help set priorities for the level of urgency to ensure timely services. To improve efficiency, they aimed to map current services with clear definitions to inform a stepped care model approach that sub-categorizes interventions. Through this project, they also planned to identify areas of need from EMHware/software to track workflow.

What were the improvements?

• Implemented a formalized assessment tool – the interRAI – for brief services. Subsequently, clients were placed on a shorter waitlist with identified and consistent care pathway options, ensuring appropriate oversight and interactions with clients as they waited.  

• Developed recommendations to implement needs-driven assessments and a planning process with clear eligibility, exclusion, and priority criteria.  

• Provided triaging recommendations to help prioritize and map current services with clear definitions. Regular waitlist check-ins and monitoring were also implemented to re-assess clients' needs.  

• Trained staff members on EMHWare to track workflow.

What was the impact?

The project focused on initiatives that will inform and complement other recommended projects. By identifying key indicators, the team made recommendations to leverage their data to guide subsequent steps in the improvement phase. They intend to mobilize the learnings from their improvement journey by adopting and incorporating the Quest methodologies and tools into future projects. This is part of a larger effort to develop a QI culture with the capacity to attain meaningful change beyond Quest.

What was the opportunity?

Maltby Centre partnered with Kairos, a youth diversion program, to work on improving concurrent mental health and addictions services in the Kingston, Frontenac and Lennox & Addington (KFL&A) area. Young people with concurrent mental health and substance use and addictions needs lacked consistent access to concurrent and integrated mental health and substance use and addictions services. These services were provided in silos in KFL&A, with limited integration between various service providers in the community.  

What was the goal?

Their goal was to ensure that young people with both mental health needs and substance use concerns were identified and able to access concurrent and integrated services through the Maltby Centre and the Kairos Program at Youth Diversion in an efficient and effective way.

What were the improvements?

• Improved the identification of clients presenting with concurrent mental health and substance use needs.  

• Improved the referral process to the substance use treatment program at Kairos and vice versa to mental health services at Maltby Centre. 

• Developed integrated services that are aligned.  

• Organized training sessions to raise awareness of the services at Kairos among all Maltby Centre staff. They also organized sessions for key partners on the GAIN-SS screener (short version) and future state/standardized process for identification and referral of concurrent services.  

• Created an instructional video for all staff, along with supporting documentation and resources (tipsheet, standard work: referral pathway process map, Kairos staff directory, documentation in EMHware).

What was the impact?

At the time of project completion, the team was still implementing improvements and they continued to meet as a team to monitor and implement the key activities in a phased approach. Early feedback identified that these changes have led to improvements in the cross-collaboration between the two service providers, with important activities already carried out and concrete plans well underway. 

What was the opportunity?

The youth engagement group at Open Doors for Lanark Children and Youth identified challenges that deterred their successful transition between child and youth mental health and adult mental health services. Young people frequently disengage when transitioning from child to adult mental health services, making them more vulnerable to the emergence of chronic mental health and addictions issues.

What was the goal?

Open Doors aimed to identify and implement standardized processes and pathways for transitional-aged youth that reflect their unique needs and goals to successfully engage with adult mental health services. Their goal was to improve the rate of successful transitions between providers to support continued mental health support and service during this challenging life stage for young people.

What were the improvements?

What was the impact?

Following Quest, Open Doors began a standardization project in the agency which involved all clinical and organizational processes. The result of this work, aside from any relevant program and process updates within the agency, will be a manual of all the information about the agency processes, documents, and resources. This manual will help to onboard new staffand also serve as a reference point for current staff.  

What was the opportunity?

Clients and families at PYS expressed concerns about lengthy wait times, which hindered their access to services. In addition, with significant changes within the agency, leaders recognized the need for adaptability and deemed it an appropriate time to reassess the agency’s internal infrastructure and cultivate a culture of quality improvement (QI).

What was the goal?

The long-term goal was to reduce wait times to align with the Ministry's definition on service wait lists. PYS hoped to move towards developing a performance measurement indicator based on the Ministry’s definition that will continue beyond their Quest project and become part of the balanced scorecard performance measurement process.  

What were the improvements?

• Focused efforts on redesigning the current quality assurance committee and on creating a continuous quality improvement team to oversee and advise on QI opportunities and culture development.  

• Formulated future plans to review all current services to identify efficiencies and reduce waste.  

• Worked with community partners to clarify service pathways, reduce overlap of services, and explore opportunities to co-deliver services. 

• Internally, worked to improve data integrity, consistency, validity, utilization, and analysis. They will also work to improve communication and access to information for staff and clients and better use technology to improve processes.  

• Seek to embed evidence-informed tools to improve quality of care. 

What was the impact?

As a result of the initial scoping work with the Knowledge Institute, several initiatives were launched.  

What was the opportunity?

On average, children and young people experienced an extended wait time to access counselling and therapy mental health services. This wait time was longer for high-risk children and young people. Recognizing that delayed treatment adversely affects the mental health outcomes for children and young people, ROCK sought to address their challenges with wait times.

What was the goal?

Their goal was to reduce the average wait time for young people assigned to counselling and therapy services.

What were the improvements?

• Simplified and shortened required paperwork and eliminated multiple steps (revised and simplified templates and shortened phases).  

• Eliminated the necessity and timing of the interRAI Child and Youth Mental Health Assessment administration (only when deemed necessary based on specific criteria for administration - after their third appointment).  

• Revised, retrained, and monitored adherence to Clinical Practice Guidelines “Business Rules” (clinicians would increase and/or maintain four (4) treatment sessions per day).  

• Prioritized client flowthrough with enhanced communication, following up with inactive clients. 

What was the impact?

At the time of project completion, the QI team at ROCK continues to monitor wait times on an ongoing basis to assess if the changes implemented during this project continue to reduce wait times for accessing counselling and therapy services.