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As we enter 2017, the concept of finding joy in work may sound more like one of the warped slogans from George Orwell’s novel 1984 than a desirable and achievable goal.

The world as a whole has entered a period of change and uncertainty almost unprecedented in our lifetimes. Echoing that larger change, the medical profession here in Ontario is in its own significant period of upset, frustration and upheaval.

The incidence of burnout is growing among not just physicians, but also nurses, health profession students and residents. In Ontario especially, the workplace environment has become to many a place of tension and unhappiness.

Health Quality Ontario is committed to helping care improve in the world, but we know that is much less likely to happen when people don’t find joy in their day to day work. That is true for doctors, nurses and frankly anyone in any role in the health care system.

Creating a quality health care system can only be achieved if those within the system derive satisfaction, if not joy, from what they do. The two are inextricably linked not only to each other but also to improving the experience of patients in the system, and this is not a one way relationship.

Research shows an association between not being happy at work or being burned out and lower patient satisfaction and reduced patient safety. Canadian research has also demonstrated that providers (specifically physicians) who are healthier and practise preventive health measures are more likely to promote healthy behaviors in their patients.

Last May, I wrote about how improving the experience and work life of healthcare providers is seen by many as necessary to achieve the Triple Aim of improving a patient’s experience of care, improving population health and doing this at a reasonable cost – a concept known as the Quadruple Aim.

I also discussed how our Quality Matters framework for achieving a high quality, patient-centred health care system has incorporated this concept. At the Health Quality Transformation conference in Toronto last October, a well-attended workshop saw panelists discuss successful initiatives to achieve the Quadruple Aim from a variety of perspectives.

This is not just an Ontario discussion. In Boston last fall, the biennial International Conference on Physician Health was held under the direction of the Canadian, American and British Medical Associations. This year’s theme: "Increasing Joy in Medicine."

I was particularly struck by the words of one of the speakers at that meeting as quoted in a story from the American Medical Association:

"It’s not merely work-life balance... some people have the idea that there’s some magical work-life balance and if I only get that formula then it will all fall together for me," said Jon Kabat-Zinn, PhD, professor of medicine emeritus and creator of the Mindfulness-Based Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. "There’s only life. And so if you don’t bring your life to work, there’s no life in work; and when you get home you have no energy for life either so we’re talking about one seamless whole."

Joy at work is not something that exists independent of the rest of your life.

As we enter this new year with all its challenges, we need to work together to find the path to joy in work because that is also part of the path to the best care for our patients.

The deep passion and commitment we bring to our work must be nurtured in order to create and maintain a truly high-quality health care system.


Blog Archive


The road travelled and the route ahead

Blog posted by Dr. Joshua Tepper on January 13, 2016

Moving from good to excellent in the delivery of quality health care is a journey that will never end – better has no limit.


Not Measuring Up

Blog posted by Dr. Joshua Tepper on November 25, 2016

We’re sorry. We made a mistake. We commit to doing better in the future. Nobody wants to start a conversation this way.


Pressures mounting on Ontario’s emergency departments

Blog posted by Dr. Joshua Tepper on November 15, 2016

“The overcrowding of emergency departments is probably the largest impediment in our health care system to deal(ing) with any surge event,” the Ontario-based Centre for Excellence in Emergency Preparedness wrote a decade ago.


Quality standards for quality care

Blog posted by Dr. Joshua Tepper on November 7, 2016

Living with dementia in a long-term care home without being automatically restrained with anti-psychotic drugs if you experience agitation or aggression.


Involving patients – how to do it

Blog posted by Dr. Joshua Tepper on October 29, 2016

A high-quality health care system cannot exist without the active and meaningful participation of patients and the public.


How has public reporting made a difference ten years on?

Blog posted by Dr. Joshua Tepper on October 13, 2016

The history of public reporting in Ontario is a short one. And its significance comes to a point as Health Quality Ontario publishes its 10th yearly edition of the performance of our health care system.


Health Quality Transformation 2016

Blog posted by Dr. Joshua Tepper on September 22, 2016

At a conference centred on health quality transformation, we welcome a globally-acknowledged leader of large scale change.


Health equity: the work we’re doing in cooperation, and the collective efforts that remain

Blog posted by Dr. Joshua Tepper on July 26, 2016

Health equity is one of the six dimensions of quality, as defined by the Institute of Medicine and adopted by Health Quality Ontario.


How are we serving those nearing the end of their lives?

Posted by Dr. Joshua Tepper on July 4, 2016

HQO’s latest report looks at palliative care. We look at the care and services people received during their last month of life to understand how the health care system is serving people as they near the end of their lives.


Ignoring Complaints is not an Option

Posted by Dr. Joshua Tepper on June 17, 2016

When you’re on the receiving end of a complaint, it can sting. I know from experience that sinking feeling of having disappointed those I am committed to serving.


Exploring Common Barriers to Care Coordination

Posted by Dr. Joshua Tepper on June 2, 2016

Health Quality Ontario’s latest report reviews responses from a recent Commonwealth Fund survey of family doctors across Canada and the world and shows areas where Ontario’s care services can improve.


Share Feedback on Our New Quality Standards

Posted by Dr. Joshua Tepper on May 26, 2016

We’ve posted the latest drafts of our first three Quality Standards. Please read them and share your comments.


The Next Step for Better Quality Care

Posted by Dr. Joshua Tepper on May 18, 2016

Often when we talk about improving health care, we turn to the Triple Aim.


Understanding and Addressing the Complexities of Addiction

Posted by Dr. Joshua Tepper on May 11, 2016

Dr. Joshua Tepper takes a closer look at two programs in Ontario that prioritize integrating care to improve treatment for mental health and addictions issues.


Want to Improve Integrated Care in Ontario? Submit Your Project Proposal Now

Posted by Dr. Joshua Tepper on May 4, 2016

The Adopting Research to Improve Care (ARTIC) Program wants to support the next great project proposal that spreads integrated care across the province.


Why Planning for Quality Improvement Matters

Posted by Dr. Joshua Tepper on April 28, 2016

The newly submitted 2016/17 Quality Improvement Plans are now available for your review – each tells a story of commitment to quality.


Opportunities for Health Equity in Ontario: A Closer Look

Posted by Dr. Joshua Tepper on April 20, 2016

Health Quality Ontario’s latest report shows inequities in people’s health risks, care and outcomes based on their income.


Who Cares for the Caregiver?

Posted by Dr. Joshua Tepper on April 5, 2016

Health Quality Ontario’s latest report focuses on the challenges faced by Ontario’s informal and unpaid caregivers who look after long-stay home care patients.


Introducing Our New Patients and Family Advisory Council Guides

Posted by Dr. Joshua Tepper on March 10, 2016

Health Quality Ontario releases three new informative guides for patient and family advisory councils.


Help Set the Standard: Introducing Our New Quality Standards Program

Posted by Dr. Irfan Dhalla on February 8, 2016

Learn about Health Quality Ontario’s efforts to develop concise and easy-to-understand Quality Standards for patients and clinicians.


It’s Not a Choice: Quality Care Needs Relationship and Measurement

Posted by Dr. Joshua Tepper on January 13, 2015

Pursuing the six dimensions of quality for improved patient outcomes.


Let’s Make Our Health System Healthier

Posted by Dr. Joshua Tepper on December 21, 2015

New strategic plan launched by Health Quality Ontario.


Taking Stock: New Report on Mental Health and Addictions Services in Ontario

Posted by Dr. Joshua Tepper on December 16, 2015

Health Quality Ontario and the Institute for Clinical Evaluative Services have released a new report exploring the quality of the province’s mental health and addictions services.


Six Things Medical Students and Trainees Should Question

Posted by Dr. Joshua Tepper on December 4, 2015

Choosing Wisely Canada Campaign aims to change the culture of medical education by addressing behaviours that can lead to unnecessary care.


The Importance of Evidence in a Learning Health System

Posted by Dr. Joshua Tepper on November 25, 2015

Health Quality Ontario launches its new three-year plan for evidence-based recommendations and Quality Standards.


Partnering with Families to Improve Patient Experience and Outcomes

Posted by Dr. Joshua Tepper on November 16, 2015

A newly launched campaign calls on hospitals to extend family visiting hours.


New Report: Quality in Primary Care

Posted by Dr. Joshua Tepper on November 10, 2015

Health Quality Ontario releases new report that reveals not everyone in Ontario is receiving the same level of primary health care.


Measuring Up: Health Quality Ontario Releases Yearly Report

Posted by Dr. Joshua Tepper on October 19, 2015

Find out the results of our yearly report: A look at the quality of care in Ontario using indicators from the Common Quality Agenda.


Quality Matters: A Playbook for Health System Improvement

Posted by Dr. Joshua Tepper on October 14, 2015

Health Quality Ontario issues a call-to-action for health system quality improvement in Ontario.


Introducing Health Quality Ontario’s Patient, Family and Public Advisors Council

Posted by Dr. Joshua Tepper on October 10, 2015

New council gives us opportunities for patients, families and the public to inform our work


Teachable Moments: Learning from Patient Complaints

Posted by Dr. Joshua Tepper on September 16, 2015

Newly implemented government regulations are set to improve the state of patient relations in hospitals across Ontario.


ARTIC Funding is Back

Posted by Dr. Joshua Tepper on September 10, 2015

The Adopting Research to Improve Care (ARTIC) program is on the lookout for the next project to scale and spread across the province.


Sign Up to Receive Our Long-Term Care Practice Report

Posted by Dr. Joshua Tepper on July 24, 2015

Physicians can sign up to receive our latest report to help inform their quality improvement efforts.


Helping Health Care Providers Strengthen the Health System

Posted by Dr. Joshua Tepper on June 26, 2015

Behind the scenes at Health Quality Ontario: Understanding What We Do.


Using Patient Experiences to Improve Care in Primary Care

Posted by Dr. Joshua Tepper on June 18, 2015

Health Quality Ontario has released a new survey tool to measure patient perspectives of care in primary care.


Announcing ARTIC’s Two Newest Projects

Posted by Dr. Joshua Tepper on June 10, 2015

Mental Health and integration take centre stage through the Adopting Research to Improve Care program.


Antipsychotics: The Art of Balance

Posted by Dr. Joshua Tepper on May 20, 2015

Health Quality Ontario’s latest report examines variation in antipsychotic medication use in Ontario’s long-term care homes.


Introducing Our New Patient Advisors Council

Posted by Dr. Joshua Tepper on May 11, 2015

Help improve Ontario’s health system for tomorrow.


Health Quality Conversations: A New Way to Tell Our Story

Posted by Dr. Joshua Tepper on April 29, 2015

Using video blogs to get to the heart of health quality.


A Cross-Sectorial Look at Integrated Care and the Patient’s Perspective

Posted by Dr. Joshua Tepper on April 23, 2015

HQO’s latest report on QIPs combines quality improvement data with the patient’s voice to explore the state of integrated care in Ontario.


How Do Ontarians Experience Integrated Care?

Posted by Dr. Joshua Tepper on April 14, 2015

New report compares care coordination and communication on an international scale.


Integration: The Next Quality Frontier

Posted by Dr. Joshua Tepper on April 7, 2015

Moving from Sectors to One System; from Ideas to Implementation.


Celebrating Leaders in Quality

Posted by Dr. Joshua Tepper on March 23, 2015

Recognizing leaders in quality and safety across Ontario.


Putting People and Patients First

Posted by Dr. Joshua Tepper on March 13, 2015

Practicing Patient Engagement in a Meaningful Way.


Insights into Quality Improvement: New Sector-Wide QIP Reports Published

Posted by Dr. Joshua Tepper on January 8, 2015

With the release of our latest reports on the quality improvement efforts of Ontario’s health system, here’s a closer look at how progress unfolds in health care.


Introducing NSQIP: Ontario’s Newest Quality Improvement Program Launches This Month

Posted by Dr. Joshua Tepper on December 18, 2014

Health Quality Ontario is issuing a call to hospitals to apply to take part in a new surgical quality improvement program.


Posted by Dr. Joshua Tepper on December 15, 2014

This week, Health Quality Ontario releases its latest report, End-of-Life Health Care in Ontario, with key recommendations to improve the quality of care for all Ontarians.


Health Quality Transformation: Patients Take Centre Stage

Posted by Dr. Joshua Tepper on December 4, 2014

Delivering the best care involves exchanging ideas between patient and provider as part of an ongoing dialogue about quality improvement.


Measuring Up

Posted by Dr. Joshua Tepper on November 20, 2014

What data and the patient voice tells us about how our health system is performing.


Quality Improvement’s Greatest Challenge

Posted by Dr. Joshua Tepper on October 21, 2014

Examples of excellent quality care abound in our health care system, often in small pockets of success.


Measuring Primary Care Performance: Our First Milestone

Posted by Dr. Joshua Tepper on October 15, 2014

A couple weeks ago we completed phase one of our Primary Care Performance Measurement (PCPM) initiative.


Monitoring What Matters: Working Together to Achieve Change

Posted by Dr. Joshua Tepper on August 5, 2014

I am delighted to announce that we have recently completed recruitment for our senior team.


The Ideas behind IDEAS

Posted by Dr. Joshua Tepper on April 10, 2014

Quality improvement (QI) work at its core is about change; it is also highly skilled work with requisite knowledge and skills.


The Challenge of Change

Posted by Dr. Joshua Tepper on March 24, 2014

I have been thinking about the surgical checklist study published in the New England Journal of Medicine a couple of weeks ago by two Ontario physicians.


Variation: A Vexing Problem in Achieving Quality

Posted by Dr. Joshua Tepper on March 13, 2014

There are many shining examples of evidence-based best practices with great outcomes in Ontario.


The “F” Word

Posted by Dr. Joshua Tepper on February 24, 2014

“Failure” is health care’s “F” word. Admittedly nobody likes to fail but many leaders, successful companies and entire sectors have learned to not only accept failure but to expect and celebrate it.


Listening to Patients and Improving Care

Posted by Dr. Joshua Tepper on February 13, 2014

I recently watched a YouTube video that I’m sure a lot of people reading this will have seen by now because it’s received attention across the globe.


Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

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