In January 2016, while reviewing targets for fiscal year end, it was noted that the timeliness of documentation in client records was not in accordance with Madison policies. This impacts on Madison’s ability to ensure safety for our clients and best meet their needs through effective planning.
By September 30, 2017, 100 percent of OCAN, Case Notes, and required documentation will be completed in the client file within established timelines noted in the organization’s policies.
EQIP Support to the Project
- QI coach: Linda Saunders
- Data Coach: Abel Gebreyesus
Madison Community Services is a multi-service agency that supports people with chronic mental health and addiction issues. Madison began in 1977 as one of the first community-based supportive housing agencies in the province. Its first supportive housing property was on Madison Ave, in downtown Toronto – which was how the community based agency it got its name.
Madison recognizes the important role that completed documentation plays in ensuring that clients are able to reach their goals. Through a review of client files, it became clear that timely completion of Ontario Common Assessment of Need (OCAN) and case notes was an issue and would affect this part of service delivery.
Beginning with a process map to understand the steps in the data collection process, the Madison team was able to understand documentation flow that followed a client’s service path and prioritize actions. The project team worked with their coaches to gather data as a next step. This has been a bit challenging due to the structure of and reports available in the IT system. However, the team has continued to work to get accurate estimates and definitions of documentation completion rates.
Using the fishbone diagram, a larger team was able to begin identify root causes that interfere with timely documentation. Through that same process they used a “dotmocracy” system to vote on and identify the most common problems. They then translated that to a Pareto chart, to see the frequency and detail of the root causes.
One issue that Madison identified as key to moving forward with the project was the definition of completion, particularly of the OCAN as this is one of the first steps in developing recovery plans and completing relevant case notes. Ultimately, they developed a four-part definition, which they expect will help in narrowing in on change ideas to target this problem.
“Although we started with a narrow focus, in working with our coach, we expanded it a bit. However, every time we dig a bit deeper, we discover new issues that are interconnected”. This speaks to the importance of a robust diagnostic process in ensuring a successful and sustainable QI projects.
From the Executive Director’s perspectives, Jean Stevenson, “The EQIP project and tools were really helpful for us. It was a real eye-opener for us to identify some of the challenges we have. We believe this learning will have a lasting impact on us and our services and ultimately improve our services significantly and better serve our clients.”