Google Analystics

Thursday, 30 July 2015

Wednesday, 29 July 2015

Recommendation/Endorsement from Myostat Motion Control

Myostat Motion Control Inc. recently passed their certification audit for ISO 9001:2008 with flying colours. I am very appreciative of the recommendation that their CEO and President, Chris Murray, wrote on my LinkedIn page:
Myostat brought Terry on board to consult on our ISO 9001:2008 preparation and initial certification audits. The project was a great success due to his insightful observations and firm guiding hand. Everyone at Myostat appreciates the hard work, flexibility, expertise, and professional attitude that Terry brought to the team. I highly recommend having him on your side for any project management or quality management initiatives.

Thanks for the kind words, Chris. What a pleasure it is to work for a CEO who is, himself, the Management Representative for Quality.

Monday, 20 July 2015

Ontario Long Term Care Homes: comparing fundamentals

Finding a Long Term Care (LTC) Home

Seeking admission to a long term care (nursing) home for yourself or a loved one in Ontario, Canada is a process regulated by the Province of Ontario Ministry of Health and Long Term Care. The process is administered by the local CCAC (Community Care Access Centre) in the area where the person seeking admission resides.

If you are not already familiar with the process read the web page Find a long-term care home, Information about, and how to find and apply to a long-term care home 

The above link will tell you how to do the next step: contact the CCAC (Community Care Access Centre) in the area where the person seeking admission resides. A care coordinator will help you determine eligibility and whether an LTC home is the right decision. If it is, they will then tell you to choose up to five homes. That is when your work really begins.

Assuming all the above is now behind you, the rest of this article provides pointers for some things to look at when making comparisons between homes.

Points to compare between LTC homes

You can find a list of LTC homes in say, the Newmarket area, at the Ministry of Health and Long Term Care web page: Reports on Long-Term Care Homes.

Go to the web page and click on the link, 'Find by location'.
This takes you to the page Search for LTC Homes By Location
Enter whatever town is of interest to you into City/Town and click next.

This takes you to the page Long-Term Care Homes Search Results. If you entered 'Newmarket' you would see a list of 4 homes to choose from and compare, each with a link that takes you to that home's report page with two tabs, one for the home profile, the other for the home's inspection reports in descending chronological order. You may want more of a choice. In that case, instead of specifying the town, enter the county/district.

Inspection Reports
The inspection reports should be of particular interest to you.
Resident Quality Inspection reports are reports from annual inspections by the Ministry of Health and Long Term Care, and are the most thorough. Inspection findings are presented as Written Notifications (WN). A WN may conclude with a Voluntary Plan of Correction (VPC) or, more seriously, a Compliance OrderDirector Referral or Work and Activity Order:
DR – Director Referral
CO – Compliance Order
WAO – Work and Activity Order

Not all WN's are equal. Use common sense to distinguish something like stained upholstery or missing ceiling tiles or wrong menu courses from  noncompliance that poses risk of harm to residents as with improper control of drugs and medication and broken wheel chairs or doors not locking with the correct protocols allowing dementia residents to wander.

Critical Incident Inspection reports are typically as a result of a resident experiencing some harm. When this happens, the home administrator is required by law to report the incident within a fixed period of time. The Ministry will look at the report and decide whether or not to follow up with an inspection to more fully investigate what happened and whether the home is following all required procedures.

Complaints inspection reports are as a result of Ministry follow up on an official complaint lodged by a resident or family member. Complaints are often made in confidence. There is a strict code against retaliation and abuse.

Sample list of inspection reports

In my casual observations I have found there is generally, on average, an inverse proportion between the number of critical incident and complaint reports and the length of the wait period for admission. It would appear that the most desirable and well-run homes typically have the longest queues for admission.

Health Quality Ontario Reports
In addition to the inspection reports which are focused purely on compliance with the Long Term Care Homes Act and associated regulations, there are some other important indicators that you will want to look at that focus more on quality of life. Health Quality Ontario (HQO) currently reports publicly on four quality indicators for individual long-term care homes. These indicators relate to four health topics:
  • falls
  • incontinence
  • pressure ulcers
  • the use of restraints
Once you know the name of the home for which you want to see this report, go to the HQO web page for individual homes

Click 'By Home' and then enter the first few words of the home name to get a list to choose from. Choose the desired home and click 'Search'.
You will see a table that shows how the home compares with the provincial average on each quality of life indicator. You can also see whether the home is improving over the previous year's performance and how it compares with the optimal benchmark.

Example of Health Quality Indicators

So now, you have looked at inspection reports and quality indicators for some homes and discovered that comparing homes in this way is not a trivial undertaking.  Once you find a 'maybe' home, phone the home and arrange a tour. Web sites for most CCAC's offer a list of questions to enquire on. You can find a very comprehensive tour checklist here:
or here:

Most people who do the tour do not ask questions. Don't be timid or afraid. You don't have to ask every question on the check-list, but know beforehand which are the important questions for you. If you do not feel comfortable asking in front of other people, confirm that you can phone later and ask your questions.

There is a lot of information here. I sincerely hope this is not too confusing. Just take your time to work through the steps. 

Registration and Accreditation
All LTC homes in Ontario have to be registered with the Ministry of Health and Long Term Care and are subject to inspections by the Ministry. In addition, some homes seek accreditation from bodies such as CARF and Accreditation Canada. These are standards bodies that assert with accreditation that a long term care home has certain procedures and protocols in place and abides by them. These operational procedures and protocols are in addition to those required for registration by the Ministry of Health and Long Term Care. The Ministry does not require accreditation but encourages LTC homes to acquire accreditation by granting certain funding premiums to accredited homes. Intuitively one would think that this should be a good thing. However, when it comes to complaints and critical incidents there are both accredited and non-accredited homes with a high rate of these inspections just as there are both accredited and non-accredited homes with a low rate. I recommend placing a higher reliance on your own due diligence in reviewing inspection reports rather than merely presuming that an accredited home will automatically have a better record in this regard than a non-accredited home.

I base the above advice on a statistical analysis that I did comparing accredited and non-accredited homes. You can review the two-part analysis in the following videos.

Monday, 6 July 2015

ISO 9001:2008 - Corrective Actions and Preventive Actions

Somebody asked for clarification in implementing Clauses 8.5.2 (Corrective Actions) & 8.5.3 (Preventive Actions).

I don't claim to know all the thinking behind the elimination of the term 'preventive action' in the soon to be released 2015 revision of the Standard, but I do know that many people of my acquaintance are not clear as to the distinction IN PRACTICAL TERMS between corrective and preventive action even though they can rattle off the definitions from ISO 9000 which I still find relevant and helpful: corrective action PREVENTS RECURRENCE of a nonconformity, preventive action prevents first time occurrence of potential nonconformities. The word 'prevent' is possibly the source of confusion. Indeed, if the action taken for a corrective action is to revise a process, that will likely prevent other, potential nonconformities as well as prevent the recurrence of the nonconformity or defect under consideration; that is, a preventive action comes as a by-product of the corrective action even if the potential nonconformities have not been explicitly identified, and quality will improve.

In my last position (medical devices) it was part of the process to consider the desirability of performing a preventive action after every corrective action. If the root cause analysis suggested a process change then this was usually done as a preventive action as that invariably went wider than just the nonconformity under consideration.

Image credit
The practice of considering corrective actions when doing corrections is quite common in my experience and seems like common sense. Do not skimp the very important step of investigation to fully identify and describe the problem. What, where, when, who, how often, what is the impact? This is a prerequisite to root cause analysis and risk analysis.