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Evidence to Improve Care

frequently asked questions

About Quality Standards

Quality standards are grounded in the best evidence and outline for clinicians and patients what quality care looks like.  They focus on conditions where there are large variations in how care is delivered, or where there are gaps between the care provided in Ontario and the care patients should receive.

Are you interested in learning more about quality standards and find yourself asking:

  • What are quality standards?

  • How does Health Quality Ontario select quality standards topics?

  • How are quality standards different from the other materials intended to guide patient care and that are informed by evidence?

Find below a list of frequently asked questions and a link to our Process and Methods guide.


Process and Methods guide


Quality standards outline for clinicians and patients what quality care looks like.  Focusing on conditions where there are large variations in how care is delivered, or where there are gaps between the care provided in Ontario and the care patients should receive, quality standards are grounded in the best evidence.

Developed in collaboration with patients, physicians, nurses, other clinicians, caregivers, and organizations across the province, quality standards are intended to achieve four main aims.  They will help:

  • Patients, residents, families and caregivers know what to discuss about their care with their health care professionals;
  • Health care professionals offer the highest-quality care based on the best available evidence;
  • Health care organizations and professionals measure, reflect on their practice and improve the quality of their care; and
  • Health system planners create the environment for health care professionals and organizations to deliver quality care.

Each quality standard focuses on a certain health care issue and consists of:

  • A patient guide for patients, families and caregivers so they know what to discuss about their care with their health care professionals;
  • A clinical guide for health care professionals clearly outlining, via concise easy-to-understand statements, what quality care looks like for that condition based on the evidence;
  • An information brief with data on how care is being delivered for that condition in Ontario, and the variations in care, to help people understand why a particular quality standard has been created; An information brief with data on how care is being delivered for that condition in Ontario, and the variations in care across the province
  • Quality indicators for health care professionals and organizations to help them with their improvement efforts; and
  • Recommendations for adoption at the system, regional and practice level to help health care professionals and organizations adopt the standards. In addition, practical tools are included in a ‘getting started guide’ for health care professionals for quality improvement.

With their associated recommendations for adoption quality standards provide the blueprint to enable the health care system in Ontario to work better, facilitate smooth transitions, and ensure patients receive the same high-quality care, regardless of where they reside.

 

Although quality standards are informed by the best evidence and the perspectives of frontline clinicians and patients with lived experience, they also acknowledge the necessity to provide care tailored to the individual patient.

The 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. 

We look for topics where there is potential to make significant improvements in the quality of care for that condition in Ontario.

Topics for quality standards are identified through suggestions from anyone; consultations with professional experts, patients, their families and other informal caregivers; and the identification of variations of care and emerging health issues.

The following criteria help to guide the decisions on which quality standards to develop:

  • Are there gaps between current practice in Ontario and optimal care as supported by the evidence?
  • Are there gaps between current patient health outcomes in Ontario and patient outcomes achieved in other jurisdictions?
  • Are there unwarranted variations in practice or outcomes across regions, institutions, or populations in Ontario?
  • What is the burden of disease and potential for overall health gain in the population or service area?
  • What is the importance of the topic to patients, caregivers, and the public?
  • What is the importance of the topic to the priorities of Health Quality Ontario’s partners (e.g., health care organizations and associations across the province) and the Ministry of Health and Long-Term Care?
  • Does the topic align with Health Quality Ontario’s strategic priorities and areas of focus as identified in its strategic plan?
  • Does the topic extend beyond a single health sector?
  • Does the topic affect more than one health profession?
  • Is good evidence available to support the development of clearly defined statements about what quality care should look like for the topic?
  • Are there clear opportunities and evidence-based examples of implementation and improvement that can be achieved?
 

To submit a suggestion for a quality standard topic, click here.

Expert advisory committees are created consisting of health care professionals with in-depth knowledge and experience in the topic area, and of patients, residents or their informal caregivers with lived experience. After selecting the co-chairs, we issue a public call for nominations and select a diverse group of clinical and patient experts.

Then, based on an in-depth review of the best evidence for the relevant condition, the advisory committee reaches a consensus on a concise and easy-to-read quality standard with five to 15 measurable actions needed to provide quality care for patients with this condition. These statements appear in both a clinical guide for health care professionals and a patient guide for patients, family members and other informal caregivers.

Both guides are then posted on the Health Quality Ontario website for public comment. The comments are carefully reviewed by the quality standards advisory committee created for that particular condition, and the guides are then finalized. When finalized, they also include:

  • An information brief with the data on how care is being delivered for that condition, and the variations in care, to help people understand why a particular quality standard has been created;
  • Quality indicators that health care professionals and organizations can use to assess the quality of care they provide and track improvement efforts;
  • Recommendations for quality standards adoption developed in consultation with health care professionals, associations, and patients with lived experience, with statements about system-wide and regional requirements. Recommendations for adoption also includes a “getting started guide” providing health care professionals with quality improvement tools and resources.

All quality standards at various stages of development can be found here.

All standards will be reviewed regularly and updated as appropriate.

Quality standards are distinct because they are:

  • Concise: they are five to 15 clearly written statements versus sometimes the many dozens or even hundreds that appear in many clinical practice guidelines.
  • Accessible: they are developed for health care professionals and organizations to easily know what care to provide, and for patients to know what to discuss about their care with their health care professionals.
  • Measurable: each statement is accompanied by quality indicators so health care professionals and organizations can track the progress of their efforts against the standard.
  • Implementable: they come with quality improvement tools and resources targeted to each standard, and provide system-wide and regional statements for the Minister of Health and Long-Term Care to support their update.

Quality standards are designed to improve care in Ontario and target priority areas in need of improvement.

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. They also are designed to help patients, residents, their families and informal caregivers know what to discuss about their care with their health care professionals.

Quality standards cut across health care sectors and professional bodies so that regardless of whether patients are receiving care in a hospital, a long-term care home, a primary care office, or at home, they should expect the same quality of care.

In addition, the statements in quality standards are designed to be measurable, which is often not the case with other clinical guidelines.

We broadly disseminate each quality standard with our partners; plus we design quality improvement strategies (such as what to start immediately or what is longer term) and quality improvement tools (such as getting started guides, decision aids, education and training, etc.). All of these quality improvement items are included in the recommendations for adoption with system-wide and regional statements (such as policy changes, levers, partners to work with) for the Minister of Health and Long-Term Care to consider adoption activities.

We recognize this work has implications for many in the system and are committed to working in partnership with individuals, organizations and associations to hear their perspectives and tap into their knowledge and expertise. By working hand-in-hand with others, the reach and impact of quality standards in Ontario will take hold, because of the shared commitment to quality care.

The tools and resources are determined and developed in consultation with the types of health care professionals who will use the standard the most (primary care, home care, etc.) and with the quality standard advisory committees. This includes a systematic process to ensure perspectives of front-line providers are heard and to understand the gaps and barriers to adoption.

Quality standards tools and resources could include:

  • A getting-started guide to support use and interpretation of the standard by health care professionals
  • Clinical pathways that are practical and task-oriented, designed to support use of the standard
  • Standardized order sets
  • Decision aids
  • Specific approaches to support education through partnerships
  • Other products and services offered by partners
  • Large-scale quality improvement efforts

It is anticipated, given the cross-sector focus of quality standards, that efforts by the local health integration networks (LHINs) at the regional and sub-regional levels will be instrumental in supporting adoption, including working with the clinical leadership and other team members within the LHINs.

The recommendations for quality standards adoption are the product of extensive collaboration with partners. It sets out in one place a series of supports that will facilitate the adoption of the quality standard.

These could include:

  • Policy and regulatory recommendations that enable delivery of care according to the standard.
  • Potential funding recommendations for new services (which could also initiate the need for a health technology assessment).
  • The identification of mechanisms to support advancement of the standard including recommending that organizations use their Quality Improvement Plans to commit to meeting quality improvement goals based on the standard, or if appropriate, using other types of accountability mechanisms.
  • The identification of partners, such as other provincial agencies, colleges, education programs, accreditation bodies and local health integration networks to assist with adoption.
  • A regional consideration of the plan depending on local circumstances and resources.
  • Opportunities for large-scale quality improvement initiatives and support, to help advance the standard.
  • Suggested ways to monitor the use of the standard.

The recommendations for adoption look at the standard as a whole, as well as each of its specific statements. The plan is developed after a rigorous assessment in partnership with each quality standard advisory committee, our partners, and the Ontario Quality Standards Committee.

It’s a standing committee of the Health Quality Ontario Board, consisting of patients, health care professionals, implementation scientists, population health experts and others from across Ontario. The committee assists Health Quality Ontario in fulfilling its legislated mandate to make recommendations on standards – be it Health Quality Ontario quality standards or other clinical care standards and performance measures – to health care organizations, the Minister of Health and Long-Term Care, and other entities.

This committee plays a key role in advancing the quality standards program, while also playing a broader role in Ontario's health care system. It works in partnership with individuals, organizations and associations to strengthen the uptake of standards and drive improvement.

The goal of this committee is to improve consistency of care across the province by enabling a more focused approach to standards prioritization, development and adoption.

For more information on the Ontario Quality Standards Committee, click here.

Health Quality Ontario’s quality standards and other clinical care standards continue to be developed by expert advisory committees consisting of clinical experts and patients with in-depth knowledge and experience in particular topic areas.

The standards developed by these advisory bodies are then referred to the Ontario Quality Standards Committee, which considers the issues affecting the feasibility of implementing them across different regions, sectors, and care settings.  Committee recommendations take into account all considerations in order to define how a standard (be it a Health Quality Ontario quality standard or other clinical care standard) could be implemented, including the supports at a health-system level required to make adoption possible.

For more information on the Ontario Quality Standards Committee, click here.

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

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