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Dr. Joshua Tepper
Dr. Joshua Tepper

Quality care: Let’s Talk About It

(On June 20, I will host a discussion on Twitter about quality and health care. This blog provides the context for that Tweet chat)

Most of us can recognize quality in clothes, cars or conversation.

But defining quality in health care delivery or in a health care system is not nearly as simple.

As a recent report prepared for Health Quality Ontario stated:

Health care quality is a challenging concept that is hard to put into words. But when quality is experienced, it is unmistakeable. When a patient receives the right treatment at the right time in the right setting, that is health care quality. When a primary care physician and a specialist are able to work in concert in the best interest of a patient, that is health care quality. When system funders and institutions have the timely information they need to craft evidence-based policies and procedures, that too is health care quality

Discussions about quality in health care can have a unifying effect but they can also be potentially divisive, especially when meanings are not totally clear. When we have a conversation of quality writ large it becomes a more robust conversation, but also becomes more difficult.

Ontario's Excellent Care for All Act, 2010 established Health Quality Ontario as the provincial advisor on health care quality. Since 2010, Health Quality Ontario has worked to quantify and qualify exactly what quality means in the context of health and the health care system.

A major step forward in this process came in 2015 when a report was released by Health Quality Ontario that builds the case for a provincial quality framework and shares a set of principles and key factors that must be considered to focus quality within the core of the health system.

At the core of this work was the articulation of the six domains of a high-quality health care system (borrowed from the Institute of Medicine) as being: safe, effective, patient-centred, timely, efficient and equitable.

From this came a vision for health care quality:

Ontario’s health system is world-leading in delivering the best outcomes across all six dimensions of quality. Our health care system is just, engages patients and families, and is relentlessly committed to improvement.

Having set out the vision and principles underlying a quality system, the committee working on this project then delved more deeply into how to implement such a system in Ontario.

Released in April, this report acknowledges that Ontario still does not have a high quality healthcare system for everybody, with the health system working well only for some people, with some conditions, treated some of the time. The report sets out a number of recommendations for organizations, including Health Quality Ontario, in how to better understand quality health care, and how to deliver that care and foster a culture of quality.

Talking about quality across all six dimensions has to involve all stakeholders in the system – from governments, to hospitals and health authorities, to health care providers, patients and caregivers.

These conversations are essential if we are to move forward and make quality care a reality for everybody in the province.

Join us on Twitter, Tuesday, June 20 at 1 pm ET as @hqontario hosts a chat on quality moderated by CEO @drjoshuatepper #HQOChat.

The chat will be framed on the following four questions.

Q1 What does quality health care mean to you?

Q2 What do you believe the barriers to be in developing a quality health care system in Ontario

Q3 What examples of quality can you point to in Ontario’s health care system?

Q4 What next steps should be taken to embed quality into the health system in Ontario?

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3 comments on article "Quality care: Let’s Talk About It"

Dennis Kendel

Hoping to join


Diana Warbin

I think the easiest way to imbed quality into the health system is to make available to all Ontarians, the following: NAMI Family to Family Education Program; Strengthening Families Together; Family M.H Recovery Series(toronto.cmha.ca). Also respite coverage for those attending if possible/required. If the shortage of available Psychiatric help in Northwestern Ont. is not quickly fixable then the funding should be streamed into accessing programs currently available through the Toronto branch of the Canadian Mental Health Association.


Philip Dourado

The main thing you should do is stop using the present tense in your vision statement. "Is" fools the brain into thinking it already exists. Latest research shows this old-fashioned form of positive thinking - describe the reality you want as if it exists - creates a fake language that is used within organizations AS IF it exists already. Gradually, any voice for improvement that speaks as if the ideal vision and the ideal values stated by the organisation aren't being lived - aren't in existence yet - become seen as disloyal criticism. And you get the whole 'whistleblower' culture that infects ALL health systems across the world: the people who speak the reality and it differs from the 'official reality' in the vision, are demonised and hounded out. That's the uintended consequence of this old-fashioned approach to creating a 'vision' and then steps needed to move from the current reality to that 'vision'. You actually sabotage the journey from the start by fooling the brains of everyone involved into subconsciously defending the current culture as if you are there already. So, step one is simple: change the wording of your vision and values so they are not in the present tense. The real conversations that you need to become the dominant form of conversation in the organisation can then be built within an online community of practice for your leaders, where they learn from each other through frank, honest leadership conversations. Hope this is helpful. I used to be leadership advisor to the Director of Clinical Governance in the NHS, and I learnt this stuff the hard way through experience there. Phil Dourado, www.theleadershiphub.com

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