Locally Driven Collaborative Projects (LDCP)

Continuous Quality Improvement

Strengthening continuous quality improvement in Ontario’s public health units

Purpose

Continuous quality improvement (CQI) is an overarching management philosophy and/or framework that drives the daily work of all employees towards organizational excellence. It includes the systems and structures of the agency that encourage and support quality improvement work throughout the agency. The goal of CQI is to improve programs and services by using data to test, analyze and improve processes.

With the emphasis on quality and continuous organizational self-improvement in The Ontario Public Health Standards, it is more important than ever to understand how to strengthen CQI in Ontario’s public health units (PHUs). To date, there has been little guidance on how to go about CQI in PHUs. They are at different stages, and it has been difficult to share information, learn from each other, and develop common ways of doing things.

The goal of this project was to strengthen continuous quality improvement in Ontario’s PHUs. Strategies and tools to support robust and sustainable CQI in Ontario’s PHUs were developed and shared.

Project Summary

The Locally Driven Collaborative Project (LDCP) on continuous quality improvement (CQI) has been investigating ways to strengthen CQI in Ontario’s public health units (PHUs) since 2016.

This project brought together stakeholders such as public health unit staff, Health Quality Ontario (HQO), and academic partners to help design, implement and evaluate the project. Previously completed research which included survey results from public health unit staff and a scoping review, provided the foundation to build on these findings.

The research objective in Phase 1 of the CQI LDCP (2016-17) was to understand the current state of CQI in public health and what can be done to support CQI within and across health units. The project completed a survey of staff in participating health units and a scoping review of the literature.

Phase 2 (2018-19) of the project aimed to develop a best practice approach to strengthening CQI within and across Ontario’s public health units, and to facilitate movement along the CQI maturity continuum. The project consulted with PHUs and other partners in the public health sector to agree on CQI language and collected and analyzed case studies of CQI work that has been done in PHUs to learn what has been useful and what has not helped.

Several tools and reports were developed for use by public health units. These are available below, and on the Health Quality Ontario Quorum site.

Resources

Project Updates

• December 2019
• How to join Quorum

Reports/Publications

• Cross-Case Analysis Summary Report
• Quality Improvement (QI) Maturity Tool Report
• CQI Scoping Review
• CQI Scoping Review Search Strategy

Tools/Infographics

• Quality Improvement Policy (Working draft)
• Whiteboard Video about CQI
• Project Update - March 2019
• Infographic - QI Maturity Tool Survey
• Infographic - Scoping Review

Population Health Assessment

The Children Count Pilot Study: Utilizing the school climate survey for coordinated health surveillance and planning for children and youth in Ontario

Purpose

Ontario does not have a system that allows for the consistent monitoring of child and youth health information for local communities. Information on children and youth is needed at the local level to make evidence-based decisions on health and well-being programs that better meet the unique needs of this population. Through our collaborative research between provincial school boards and public health units, we have developed and piloted a new Healthy Living Module (HLM) that addresses healthy eating, physical activity, and mental health for inclusion in or use with the School Climate Survey (SCS).

Project Summary 

Background
Phase One of this multi-year collaboration began with an assessment on the health data gaps for children and youth in Ontario, through surveying all public health units and interviewing key informants from academic institutions, government and Directors of Education. Key findings from this report, released in 2017 and available below, identified mental health, physical activity and healthy eating as high priority topics for which improved local data collection is needed, and that a Task Force should be convened to identify next steps for improving monitoring and assessment of child and youth health and well-being in Ontario.

In summer of 2017 the team established the Children Count Task Force, consisting of leaders from public health units, non-governmental organizations, education, government agencies, ministries, and researchers in this field, to identify solutions and make recommendations for improving monitoring and assessment of child and youth health and wellbeing. The Children Count Task Force recommended building upon the existing system to address gaps in health information by enhancing the mandated school climate survey. This included standardizing questions for healthy eating, physical activity, and mental health. The full Task Force recommendations are available below (released in 2018 and updated in 2019).

Children Count Pilot Study
Building on the recommendations from Phase One, the Children Count LDCP team engaged in a two-year pilot process utilizing the SCS for coordinated health monitoring and assessment. This pilot included:

• Collaborating between public health units and school boards to develop and test a health module in the SCS that asks about healthy eating, physical activity, and mental health;
• Evaluating the applicability and feasibility of the partnership between public health units and school board; and
• Developing a toolkit for school boards to support them in undertaking coordinated assessment and health service planning using the SCS in partnership with public health units.

The pilot began in December 2017 with the recruitment of school boards as pilot sites (n=5). School boards represented the diversity across the province (including Catholic, public, French, rural, northern, urban), and was built on expanding existing relationships between school boards and public health units. The pilot used a participatory action research model that had school boards and their health unit counterparts forming the research steering committee, governing every aspect of the research from implementation to analysis. The resulting 16-question Health Living Module (HLM) includes questions on not only healthy eating, physical activity, and mental health, but sleep, bullying, and relationships, and can be incorporated into the SCS or implemented as a separate stand-alone survey.

Impact

 School boards and public health units who have included the HLM in their SCS have found the HLM data helpful for strengthening their partnership, creating more responsive programs, and identifying areas of strength and opportunity for schools. Schools utilized the results to inform their school health action plans and mental health strategies and health units used results to inform programs targeted and tailored for their school boards specific needs.  The toolkit, available below, provides practical strategies and tools to support school boards embarking on including the HLM in their SCS. The toolkit includes sections on developing partnerships, planning and administering the survey, analyzing the data, and sharing and using the results. The HLM is available in Appendix A. A report is also available below, which describes the experience of school boards and local public health administering, analyzing, and disseminating the SCS in the five pilot sites. The R syntax for analyzing HLM data is available upon request.

Resources

• Children Count Pilot Study Report (2019) 
• Children Count Pilot Study Toolkit (2019)
• Children Count: Provincial Task Force Recommendations (2019)
• Children Count: Provincial Task Force Recommendations Summary (2019)
• Final Report (2017)
• Final Summary Report (2017)

Measuring Food Literacy

Purpose

What we eat influences our health. Poor diet puts us at risk of heart disease, some cancers, diabetes, poor mental health, and blood pressure. Research shows that food literacy, along with other strategies, may improve healthy eating. Further exploration on the benefits of food literacy programs is needed to understanding how food literacy can improve healthy eating, reduce the risk of illness, and maintain good health. 

A tool that measures food literacy is key in planning successful public health programs in Ontario. When program funding is limited, we need to know how to best plan, implement and evaluate food literacy programs. A tool to measure food literacy will help us determined which programs are most effective.  

Project Summary

In 2016, our Locally Driven Collaborative Project team conducted research to create a list of key attributes (or characteristics) of food literacy. In consultation with food literacy experts and staff working in public health, 12 attributes, placed into the five categories were identified:          

• Food and Nutrition Knowledge (knowing about the variety of foods, where food comes from, and nutrients in food and how they relate to health);
• Food Skills (i.e., through all of life being able to prepare meals safely using basic skills like chopping, measuring, cooking, and reading recipes);
• Self-Efficacy/Confidence (i.e., being able to select, buy, prepare, and cook healthy food in a variety of settings; picking out what is ‘healthy and ‘unhealthy’; knowing how to find reliable information; and having a positive attitude towards food and trying new food;
• Food Decisions (i.e., making healthy food choices);
• External Factors - Impact health and environment and may affect food literacy:
  • Social Factors (i.e., good wages, enough food, safe housing you can afford, the tools to prepare food, places to learn about healthy eating)
  • Food System (i.e., how we grow, process, transport, consume, and dispose of food)
• Culture and Beliefs (i.e., cultural and family food practices, eating together, having family and/or other social supports) Creating a Food Literacy Tool

To build on this research, our team will work with a Research Consultant to develop and test a tool. This tool will measure food literacy with high-risk groups including:

• youth (aged 16 to 19 years),
• young parents (aged 16 to 25 years),
• pregnant women (aged 16 to 25 years).

To plan our study, we looked at how similar tools (e.g., NutriStep^®, Healthy Eating Index, SCREEN) were developed. We also talked with some of the researchers involved in making these tools.

Key questions for the food literacy tool will be created and  organized according to the 12food literacy attributes.  Different tests will be used make sure the questions in the tool collect the information we want to know about food literacy.

Once the tool is created, further testing will occur that will involve the  same target groups  so the tool can be used by public health staff working with these high-risk groups. 

Impact

Once testing is complete, we will have created a high-quality tool that measures food literacy in the target populations we have identified; collects data on how well these programs run; makes changes to programs; and uses data to advocate with the government and other key agencies for additional food literacy resources. 

Resources

• Project Update - September 2017
• Project Update - August 2016
• Food Literacy Framework - Infographic
• Call to Action for Public Health Units

Built Environment

Healthy Built Environment – A Provincial Framework for Healthy Community Design

Please note that this project was initiated through Cycle 5 of the LDCP program, however led and supported by the Simcoe Muskoka District Health Unit.

Purpose

Our health is influenced by where we live. Healthy community design can influence an individual’s lifestyle, behaviour, environmental contaminant exposure, and consequently, their health, wellbeing and quality of life. Public health has an opportunity to influence community design and improve population health, however, creating healthy community design is a complex process involving many stakeholders and processes. This project will result in an evidence-based resource that can be used by Ontario public health units to support them in the municipal planning and community design process.

Project Summary

Phase 1 of this project consisted of a review of reviews to identify the elements of health protecting, health promoting and health equity promoting design as well as documenting the health impacts associated with community design. The resulting knowledge product, linked below, was a repository of resources from the public sector, non-profits, think tanks, professional associations, and scholarly literature.
Phase 2 of this research focused on identifying promising practices being used by public health units in Ontario to engage with their communities. Through an online survey and focus groups, four promising practices were identified, including planning for collaboration, acquiring planning and process knowledge, establishing relationships, and using evidence to influence and mobilize. The team also mapped the municipal planning process in Ontario through conducting key informant interviews and reviewing relevant legislation and key provincial policy documents.

Impact

Through this work, public health professionals now have access to evidence-informed promising practices that provide examples and guidance to support their engagement in healthy community design. Mapping the municipal planning process has also identified new opportunities and pathways for public health to influence the built environment and create healthier communities. You can read more about the project, and view all of the knowledge products at www.PlanningForHealth.ca. 

Resources

Promising Practices for Healthy Built Environments in Ontario’s Public Health Units

Mapping the Municipal Planning Process in Ontario: Opportunities for Public Health Input

Resources for Practitioners

Health Equity Data Mobilization

Sharing health information with community organizations to promote healthy living for all

Purpose

Advancing health equity in our communities requires collaboration between local public health agencies (LPHAs) and community partners. Access to community demographics as well as behavioural and health outcome data is important for identifying opportunities and gaps in health equity work. This project will use a collaborative approach that encourages leadership among community partners , fostering sustainable data sharing opportunities between LPHAs and their partners.

Project Summary

Currently, there is no sustainable and consistent system for sharing data between LPHAs and community organizations (such as YMCA, March of Dimes, Children’s Services). As a result, community organizations are hindered in their ability to better understand priority populations,

• inform programs and services that address priority needs,
• support funding proposals and
• participate in local advocacy efforts in their communities.

This project aims to identify best practices to select, analyze and distribute key behavioural and health outcome data for health equity work. The project will be carried out in two phases followed by a knowledge exchange component.

The first phase of this project will focus on mapping the current uses of health equity-related data by community partners through an online survey. The survey will explore their needs, challenges, and enablers to accessing and interpreting data. A summary of survey results and literature review findings will inform a facilitated group discussion session with approximately 20-24 community partners. The discussion will focus on three themes:  barriers, possible solutions, and implementation considerations in data sharing and use.

The final phase will focus on developing a process to share data based on input from community partners at the facilitated group discussion. This process will inform best practices to select, analyze, and distribute key behavioural and health outcome data and will be piloted with selected partners to ensure it meets the needs of a variety of community organizations.

Impact

A guide summarizing the analyses from the online survey, literature review, and facilitated group discussion will be developed. The purpose of the guide is to encourage LPHAs and community partners to use the recommended data sharing process to advance health equity. The guide will be disseminated to key stakeholders and identified knowledge users.

Resources

• A Summary of Findings: A Locally Driven Collaborative Project on public health data sharing with community organizations to promote health equity
• Putting the Pieces Together (2019): A guide for public health to share data with community organizations to promote health equity
• Evidence Brief: Identifying Facilitators and Processes for Sharing Local Data with Community Partners to Enable Improvement in Health Equity
• Dialogue Summary: Identifying Facilitators and Processes for Sharing Local Data with Community Partners to Enable Improvement in Health Equity
• Putting the Pieces Together: A guide for public health to share data with community organizations to promote health equity
• Webinar: Using Health and Demographic Information to Support Community Services

Patients First

Public Health Units and LHINs working together for population health

Purpose

The new legislature in Ontario, called the Patients First Act, requires Public Health Units (PHUs) and Local Health Intergration Networks (LHINs) to work together in new ways.  The role of regional agencies, called Local Health Integration Networks (LHINs), is to plan how to best use resources to meet those patient needs in a cost-effective manner. Public Health Units are being asked to contribute more to health system planning with LHINs due to PHUs’ focus on population health assessment, prevention of disease and injury, protection of the public from illness and health promotion. 

Using a population health approach means looking at how to address the health needs of the whole population, not just of the patients treated in the health care system. A population health approach seeks to improve the health of the entire population and reduce health inequities among certain groups in the population.  This helps individuals, groups, and communities to have a fair chance to reach their full health potential. This also prevents disadvantage by social, economic, or environmental conditions.  

The focus of this project will be to explore and determine key elements for a successful collaboration between PHUs and LHINs, to improve the health system in Ontario informed by a population health approach.

Project Summary

Each PHU and LHIN relationships is unique. Efforts will be made to engage and interview key groups throughout the project to learn from existing collaboration in Ontario.

This project will define the expectations and offerings of both PHUs and LHINs, working towards a shared population health model. Through this research, we will determine what information can best support health system planning and delivery and whether this information takes into account all the factors that influence health over lifetimes.

Interviews will be conducted with a variety of individuals and groups that will include Medical Officers of Health, Local Health Integration Networks (LHIN) Chief Executive Officers (CEOs), Ministry of Health and Long-Term Care representatives, LHIN and PHU board members, Program managers and directors, Epidemiologists and health analysts in Ontario.

Research will be conducted in two phases: a descriptive qualitative study in phase 1 that will inform a cross-sectional online survey to be conducted in phase 2. 

Impact

The development of research products may include self-assessment checklists, to assist in determining the  key elements for successful PHU and LHIN collaborations, in addition to formal PHU-LHIN agreements such as Project Charter or Memorandum of Understanding templates.  We anticipate that PHUs and LHINs will use these tools to develop consistent and helpful approaches for  collaboration, improving the health system in Ontario with a population health approach. 

Resources

• Phase One Research Brief
• Phase Two Survey Key Findings
• Phase Two Survey Technical Summary
• Phase Two Survey Responses to Qualitative Questions (Excel workbook)
• Literature Search Strategy
• Final Report 

Relationship building with First Nations and public health

Exploring principles and practices for engagement to improve community health

Purpose

Ontario public health units deliver a broad range of population health programs. These programs aim to improve and protect the health of all and ensure everyone has equal opportunities for health. However, public health units do not systematically engage with First Nation communities to ensure a seamless public health system.

Within Northeastern Ontario, there are 39 First Nation communities where Indigenous people live on reserve land as designated within the Indian Act. This LDCP project intends to identify mutually beneficial, respectful and effective principles and practices of engagement between First Nation communities and public health units in Northeastern Ontario. Engagement, for the purposes of this project, is defined as a process of involvement through a respectful relationship.

Project Summary

Public health units have an interest in developing processes to effectively engage with First Nation communities in a respectful and mutually beneficial way. Little formal guidance is available to public health from the province on the best ways to do this. In addition, we know little about how First Nations wish to engage and collaborate with local public health units.  Outcomes from this research will be an important first step in working towards improved opportunities for health for all. This project will be conducted in two parts that will focus on a literature review and an engagement scan. 

The literature review of academic journals and other publications will explore principles and strategies of engagement and collaboration between Indigenous people and Canadian public sector agencies in the last 10 years. The purpose of the review is to find existing work for this project to build on. 

A scan for examples of engagement between public health units (or other types of organizations) and Indigenous people and communities in the past 10 years will be conducted by the research team. The goal of the scan is to identify recent examples that we can learn from to help identify successful principles and strategies, in addition to those that have failed. This scan will be completed in two phases, involving an online survey (which will be sent to the Ontario public health units that have previously engaged with First Nations) and focus groups or sharing circles (involving

Northeast Ontario First Nation communities, Tribal Councils or First Nation regional health service organizations having engaged with public health).

Implementation

Representatives with expertise, experience and Indigenous perspectives from communities within the Northeast will be responsible for guiding the project team and informing important decisions about the project’s design, direction and implementation, to ensure that the overall approach to this project includes First Nations voices.

The First Nations principles of Ownership, Control, Access and Possession, also known as OCAP will provide  a comprehensive research framework which embraces self-determination as to how data involving First Nations is collected, used and shared. 

Impact

The team will analyze and interpret the data to develop guidance in the form of potential principles and strategies for good engagement.  They will actively share results with public health units, First Nations, and others who may have an interest in developing respectful engagement strategies. 

Resources

• Project Summary
• Literature Review
  • Full Report
  • Summary
• Ontario Public Health Unit Survey
  • Full Report
  • Summary
• Key Informant Interview Final Report
• Gathering and Sharing Learning with First Nations Communities

Previous LDCP projects

This page contains reports from previous LDCP projects.

Breastfeeding

• Infant Feeding Surveillance Pilot Study: Final Report and Recommendations
• Infant Feeding Surveillance Knowledge Translation Project: Final Report and Analytic Guidance Documentation for the 6-Month Retrospective Single Time Point Questionnaire
• Infant Feeding Surveillance Knowledge Translation Project: User Guide and Report on the Analytic Guidance for the Prospective Multiple Time Point Questionnaires
• LDCP Prospective Questionnaire Multiple Time Point Data Dictionaries

Built Environment

• Healthy Rural Communities Toolkit: A Guide for Rural Municipalities

Childhood Health Weights

• Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)
• Beyond BMI: Investigating the feasibility of using NutriSTEP and electronic medical records as a surveillance system for healthy weights including risk and protective factors in children
• Beyond BMI: The collection and integration of risk and protective factor information in electronic medical records (EMRs) for childhood healthy weights surveillance in Ontario 
  • Poster Presentation
  • Fact Sheet
  • Pamphlet
• Beyond BMI: Building an EMR-based Childhood Healthy Weights Surveillance System to Include Nutritional Risk and Protective Factors Through the Collection and EMR-integration of NutriSTEP

Fall Prevention

Making fall prevention “everyone’s business” - Getting community partners to actively address fall prevention for older adults

• Research Brief
• Poster

Mental Health

• Identifying Areas of Focus for Mental Health Promotion in Children and Youth for Ontario Public Health

Patients First

• Develop and Test Indicators of Ontario Local Public Health Agency Work to Address the Social Determinants of Health to Reduce Health Inequities Phase 2 Report
• User Guide: Health Equity Indicators for Ontario Local Public Health Agencies 

Program Evaluation

• Executive Summary: Building Evaluation Capacity in Ontario’s Public Health Units: Results from ten action research projects
• Infographic: Building Evaluation Capacity in Ontario’s Public Health Units: Results from ten action research projects
• Final Report: Building Evaluation Capacity in Ontario’s Public Health Units: Results from ten action research projects

Social Media

• Social Media Toolkit for Ontario Public Health Units