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Counting on surgical teams

When it comes to taking opioids for the first time, it is not surprising that this frequently occurs after having surgery.

Opioids have become the go-to class of medications for controlling pain and after surgery, many patients require drugs to help deal with pain as they recover from a procedure. This has been documented in a major report by Health Quality Ontario released in 2017 – showing that surgeries are second only to dentists’ offices for the percentage of opioids prescribed to patients who had never used opioids before.

Now, 47 hospitals in Ontario who are part of the Ontario Surgical Quality Improvement Network have launched a campaign to reduce the quantity of opioids that surgical teams prescribe after surgery. These hospitals are responsible for almost 80% of the surgical operations that take place in the province annually.

Integrated care: Weaving a seamless web

Lee Fairclough

Moving away from a fragmented and siloed health care system to one that seamlessly connects patients to the services that they need is currently driving health care reform in Ontario.
How will this look for patients?

If you’re a patient with chronic knee pain, in most cases you will be seen and assessed by a family physician. However, in some cases you may be assessed at a rapid access clinic and, if you need surgery, seeing an orthopedic surgeon in a timely manner and having knee replacement surgery. After the operation, it means that you and your family work with health care professionals, so your needs and wishes are met when being discharged from hospital. When discharged you will have a transition plan that has been developed in collaboration with you and shared with your primary care provider. You will receive post-operative rehabilitation, education and training about self-care, and you will have a clear sense of the steps needed to ensure your recovery.

Showing how patient partnering is improving care

Over the last decade, patient partnering has grown in Ontario to the point where it is a significant part of the culture and practice of improving health care quality. It supports a high-quality health system by bringing a vital source of insight to the table and ensuring that the work being done is relevant to patient needs. If it’s done well, patient partnering produces better patient experiences, better health outcomes and increases public trust in the system.

Plus, patients want to be included as partners. They know they can make a difference in driving positive changes and to improving health outcomes.

But how does one pinpoint the desired effect of patient partnering? We all feel patient partnership is the right thing to do, but how do we know if it is being done in a way that is truly meaningful for both patients and health care professionals?

One way to evaluate the impact of patient partnering is to understand what insights are being collected and how they are being applied to the work of improving care, case by case and cumulatively over time. Evaluation helps us know whether changes made to improve care are grounded in patient needs.

Pain and parking: Capturing the patient experience

Zal Press and Anna Greenberg

A patient’s experience interacting with the health care system is one of the most important indications of how well that system is functioning. In fact, better patient experience is one of the four parts of the Quadruple Aim for health care systems (along with better outcomes, lower costs, and an improved clinician experience). Here, patient advisor Zal Press (@PatientCommando) and Health Quality Ontario’s Interim President and CEO Anna Greenberg provide their perspectives on measuring the patient experience.

Zal Press: How do patients measure their experience in the complex world of health care? Since their reason for using the system can be about pain, let’s start there. Patients are often asked to measure their pain on a scale of 1 – 10. However, as a Crohn’s patient, the pain in my gut often feels like there’s a cat trying to claw its way out and there are many times when my pain meter hits a 12 and even a 15. Pain is also a measure of success. I remember forcing myself to get up to walk, just a day after my bowel resection, to nurture the ultimate measure of a successful bowel surgery – the passing of gas.

Anna Greenberg: For years there has been a disconnect between the type of real-world experiences of patients like Zal and how the system measures their experiences. Standardized surveys are the go-to tool used by hospitals and others to measure patient experience. However, many surveys reflect the provider or administrator view of what’s important, not the patient’s perception of what’s important, and getting access to survey results (let alone using them for improvement) can take too long. Further, organizations often focus on what happens within their four walls rather than the entire experience a patient may have, such as what it was like to be discharged from hospital.

Advance care planning – we’re paying attention now

Today (April 16) is National Advance Care Planning Day, an annual event to raise awareness about detailing what kind of care you wish at the end of life and to confirm a future substitute decision-maker who can communicate your wishes and beliefs about future health care, and make decisions when you are no longer mentally capable of doing so. In this conversation, Lee Fairclough, VP for Quality Improvement at Health Quality Ontario, and Kathy Kastner, a long-standing advocate and coach for appropriate end-of-life care and planning, discuss this issue.


Lee Fairclough: In the last few years, we have seen many campaigns in Ontario and across Canada raising awareness about advance care planning. These campaigns are having an impact. Findings from the 2017 Commonwealth Fund International Health Planning Survey of Older Adults showed more senior Ontarians have had discussions relating to issues of advance care planning and substitute decision making than almost any other country or jurisdiction in Canada. That study found that:

• 70% of older Ontarians report having a discussion with family, a close friend or a health care professional about what health care treatment they would want or not want if they became very ill or injured and could not make decisions for themselves
• 47% of older Ontarians report having a written plan or document describing the health care treatment they would want or not want at the end of their life
• 70% of older Ontarians report having a written document that names someone to make treatment decisions for them if they cannot make decisions for themselves

As a society, we are thinking more about dying and end-of-life care as well as earlier and more effective palliative care.

Let’s make our health system healthier

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