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Dr. Joshua Tepper and Dr. Chris Simpson

Getting from Situational to System-wide Quality

Variations in care received by Ontario residents, based on where they live or certain demographic factors, can indicate a lack of quality in a health care system.

The recent report prepared for Health Quality Ontario titled Quality Matters: Realizing Excellent Care for All acknowledges the existence of unwarranted variations in care and the negative impact they can have on patients. This was also a key theme in last year’s Measuring Up report from Health Quality Ontario which noted that, while Ontario was generally doing a good job of providing care to all who needed it, “unacceptable variation” still existed by geography and population groups.

As a result, one of the recommendations made by the System Quality Advisory Committee in the Quality Matters report to support the delivery of quality care called for Health Quality Ontario and its partners to “produce standards for priority areas to support consistent quality improvement efforts at a local level.”

This recommendation is very much in keeping with Health Quality Ontario’s mandate to create standards. Last fall, we launched our quality standards program, rolling out initiatives to outline for clinicians and patients what quality care looks like in selected clinical areas.

Now, another step to advance this process has been taken with the appointment of a Ontario Quality Standards Committee to offer the “resolute leadership focused on improving everyone’s quality of care” that is called for in the Quality Matters report.

Reporting directly to the Health Quality Ontario Board of Directors, the committee will not only provide guidance for the quality standards program, but also has a mandate to play a broader role with all clinical care standards to drive quality improvement in the province.

It is worth stressing that not all variations in care across Ontario are unwarranted or the fault of those delivering front-line care, as variations can occur as the result of patient preferences or other justifiable reasons. There is no intent to impose regimented “cookbook” medicine on front-line clinicians and statements in each standard do not override the responsibility of health care professionals to make decisions with patients, after considering each patient’s unique circumstances.

The Committee will not develop quality standards – that is the job of expert advisory groups consisting of clinical experts and patients with in-depth knowledge and experience in particular topic areas.

What the Ontario Quality Standards Committee will do is help decide in which areas clinical standards should be produced.

Importantly, the Committee will also evaluate the feasibility of implementing the specific standards across different regions, sectors and care settings. Its recommendations will take into account what supports are needed from the health system to make it possible to implement a specific standard. This recognizes that, while some variations are unwarranted, it is not always possible for them to be addressed just by the clinicians delivering care.

The Committee will also review quality standards prior to them going to the Board for approval.

Overall, this means providing a more coordinated provincial approach to the prioritization, development, adoption and measurement of clinical care standards in Ontario.

Quality Matters notes that many types of leaders are required to deliver the promise of better quality in the health care system. We believe the patients, health care professionals, implementation scientists and population health experts from across Ontario who will serve on the new Ontario Quality Standards Committee will bring that type of leadership.

Committee members are listed here.

Dr. Joshua Tepper is CEO of Health Quality Ontario. Dr. Christopher Simpson is chair of the Ontario Quality Standards Committee

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