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Royal Commission into Victoria’s Mental Health System

Case study:

Rapid Improvement Support and Exchange

Ontario Health Teams are designed to make Ontario’s health system more responsive to local needs. They are groups of health providers who partner to deliver integrated healthcare services. The first teams were announced in December 2019. Once fully operational, they will be jointly accountable for the cost and provision of services. They will also share accountability for health outcomes and care experiences of their local population, including for mental health and addiction.

Rapid Improvement Support and Exchange (RISE) is a collaborative platform supported by a grant from the Ontario Ministry of Health, and is designed to help Ontario Health Teams achieve their goals. As health teams develop, they need to learn and improve quickly. RISE helps them do this by providing access to ‘rapid learning and improvement assets’.

According to RISE, rapid learning and improvement involves six steps:

  1. identifying a problem or goal
  2. designing a solution based on data and evidence
  3. implementing the plan (possibly in pilot and control settings)
  4. evaluating to identify what does and does not work
  5. adjusting, with continuous improvement based on what was learned from the evaluation and from other health teams
  6. disseminating the results to improve the coverage of effective solutions across the health system.

RISE provides teams with three types of support: coaching, collaboratives and communities of practice.

The more active forms of support—coaching and collaboratives—are targeted at the most difficult part of the health system transformation, namely the shift from a traditional, reactive model of care to a more practice‑based and coordinated ‘population‑health management’ approach to care.

Online communities of practice, which are less intensive, member‑driven supports, focus on the other critical building blocks of the transformation (for example, patient partnership and digital health). They provide an opportunity for teams to identify their own learning needs, to share experiences of success and failure, and to build their ability to become a sustainable, self‑improving system.

RISE also delivers an ‘on demand’ suite of activities (for example, convening ‘jamborees’ to work through important challenges like how best to engage clinicians in teams) and products (for example, briefs and analyses of evidence on priority topics like collaborative governance).

RISE uses a number of approaches to share tools and resources with teams, including a website, monthly newsletter, webinars and Twitter. It puts a lot of effort into ensuring that all products use frameworks and language specific to and consistent with the transformation project.

Professor Rob Reid, Chief Scientist of Trillium Health Partners and co‑lead of RISE, said researchers are the backbone of RISE.

Researchers help teams to push through the stages of the learning cycle. This starts with developing a deep understanding of the problem they are trying to solve, and how it has been tackled elsewhere. Then we bring science into the design of better models of care, making consumer experiences the focus, and building in the new skills, resources and ways of working that will be needed to implement them. Then we help them use the Ontario Health Teams evaluation framework to assess what’s happening when they implement new models in the field, and feed information back to them in a continuous loop so they can adjust their approach.

RISE also partners with many health system partners to support research translation, capability development and evidence building. These partners include the new Ontario Centre of Excellence for Mental Health and Addictions as well as the Centre for Effective Practice, an independent research and knowledge translation organisation focusing on primary care.

Professor John Lavis, Director of the McMaster Health Forum and co‑lead of RISE, said that government, health system partners, research partners and RISE staff are all motivated to collaborate in improving mental health services for people in Ontario.

The outcomes that matter are mental health and care experiences—and you must be able to measure and improve both. Mental health touches everyone. And we can and must do better for people.

Sources: McMaster University, Rapid-Improvement Support and Exchange, [accessed 6 October 2020]; RISE, RISE brief 12: Rapid learning and improvement, [accessed 15 December 2020]; RCVMHS, Interview with Professor John Lavis, 17 August 2020; RCVMHS, Interview with Professor John Lavis, 19 November 2020.; RCVMHS, Interview with Professor Rob Reid, 10 December 2020.