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Help Set the Standard: Introducing Our New Quality Standards Program

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

Everyone wants high-quality care. But how do patients, clinicians and administrators know what high-quality care looks like? Figuring this out can be surprisingly difficult.

I’ll share a couple of examples that illustrate this challenge.

A few months ago, I had a conversation with a woman who had just had a knee replacement. She was in a lot of pain. To my surprise, she told me that her pain was worse than it was before her surgery. It soon became clear to me that she and her surgeon had not thoroughly discussed the pros and cons of surgery – and, importantly, other potentially effective treatment options for her knee – before she agreed to the operation.

She and her family did not have the information they needed on what to expect from our health system when she was assessed for her knee arthritis. Nor did they know what to expect after surgery. In my view, this resulted in a poorer experience of care for her than would have been ideal.

These information challenges aren’t just limited to patients and caregivers within our system.

Recently, a colleague expressed exasperation regarding a quality improvement project designed to improve the care of patients being discharged from hospital. He had scoured the internet for evidence-based practices in this area but couldn’t find a concise set of recommendations supported by evidence or a consensus of patients, clinicians and administrators. He developed his own list of suggestions from scratch. But arguably what became especially frustrating for him was knowing other colleagues were doing similar work in other hospitals.

These examples point to a gap in our health system: an absence of concise, accessible, evidence-based recommendations for what excellent care should look like in Ontario.

Around the world, clinical leaders have partially addressed this issue by producing clinical practice guidelines. These guidelines serve an important purpose, but have limitations. They are often very dense. The last one I read (skimmed, if I’m being honest) was over 200 pages long. They are also not designed for patients. Many clinical practice guidelines have been criticized for other reasons too – conflicts of interest that have not been adequately addressed, a failure to consider value for money, or focusing so much on minutiae that key recommendations are underemphasized.

Health Quality Ontario aims to address these issues with our new Quality Standards program.

Each Quality Standard is a concise set of evidence-based statements that describe the key components of excellent care in Ontario for a particular condition (e.g., heart failure) or service area (e.g., access to primary care), paired with quality indicators that enable clinicians and administrators to measure their care against the Quality Standard and support quality improvement. We are writing statements from the patient’s perspective, and each Quality Standard is also accompanied by a plain language summary intended for patients, caregivers and the public.

Each Quality Standard will serve as a foundation for quality improvement efforts across the health system.

We are developing Quality Standards with groups of clinicians, patients, caregivers, researchers and administrators with expertise in each topic area to support its adoption across the provincial health system. Crucially, each Quality Standard is not only based on the best scientific evidence, but also the lived experience of patients and caregivers.

I want to acknowledge our debt to the National Institute for Health and Care Excellence – widely known as NICE – in the United Kingdom, which has been producing Quality Standards for several years. We have learned a lot from speaking with their team and examining their work.

Today, I’m pleased to announce that we are hosting an educational webinar at noon on Wednesday February 10 to discuss how our Quality Standards are being developed and how we hope they will be used. The first three topics we are developing Quality Standards for are Schizophrenia, Major Depression and Dementia with Agitation or Aggression.

We will be joined by two members of our Schizophrenia Quality Advisory Committee: Phil Klassen, co-chair of the Committee and a psychiatrist who works with patients with schizophrenia, and George Mihalakakos, a peer support worker who brings his lived experience with schizophrenia. They will share their thoughts about how the Quality Standard has been developed and why they think it is so important.

The webcast is also a chance for us to share an overview of three Quality Standards we will soon be developing: Heavy Menstrual Bleeding, Wound Care and Hip Fracture. We are looking for people – especially patients, caregivers and health care professionals – who would be interested in participating on the advisory committees for these Quality Standards.

We also welcome your suggestions for conditions or topics where we should develop a Quality Standard.

Please join us for the webinar at noon to learn more, and participate on social media by following #QualityStandards on Twitter. I look forward to sharing more with you as this program unfolds, and to all of us working together to ensure our patients receive the best possible care.

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

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