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Quality at the coalface: How front-line providers are upping their game

Dr. David Kaplan

Providing quality care should be the aim of all who work in the Ontario health care system.

However, in today’s high-pressure environment, physicians and other health care professionals practising primary care in the community or in hospitals are often challenged to find time to engage in quality improvement initiatives on top of providing the necessary care for their patients.

As Dr. Jeremy Grimshaw, Professor of Medicine at the University of Ottawa said in a recent commentary for physicians: “You want to provide the best care for your patients but often don’t have the time or energy to scan a dense and convoluted report that tells you how to do this, even if it is based on data from your own practice.”

Quality Improvement Plans: Meaningful change and more value

Lee Fairclough


As we begin a new year and look towards further enhancing quality care in Ontario, it’s a good time to reflect on the annual public commitment that health care organizations make to their communities through their Quality Improvement Plans (QIPs). These plans share what was achieved to improve care in the previous year and set out how they will improve health care quality within their organizations in the coming year.

On April 1, 2019, more than 1000 QIPs will be submitted to Health Quality Ontario by hospitals, long-term care homes, home-care organizations and primary care teams and simultaneously shared with their local communities.

It is worth remembering that QIPs have only been required in Ontario for the past eight years, starting with Ontario’s 142 public hospitals. The original QIP stated “they should be seen as a tool, providing a structured format and common language that focuses an organization on change.” This was a major shift from the prevailing, more ad hoc approach to quality most Canadian health care organizations took, where there was limited support for local improvement efforts and as a result, change was diffused.

Everything I learned about quality…

by Dr. Joshua Tepper

I am rapidly completing my five-year tenure as President and CEO of Health Quality Ontario (HQO). I am probably a bit nostalgic and reflective by nature and so this transition time has led me to think about what I have learned in the last five years about quality improvement (QI).

It is helpful for context to know that while I probably brought a certain set of useful skills and knowledge to the role of CEO, I did not have a strong background or formal training in QI. These reflections then are not about a lifetime (or decades) of thinking about QI, but rather just the last few years.

To be clear, this is not a reflection or effort at summation of the good work that HQO and its partners have done in the last five years. Rather, this is a personal look at what I see as key themes in the still emerging and rapidly evolving space of quality improvement in health care.

I acknowledge that I have written about some of these ideas in other blogs. Also a recent set of comments (not really a speech) at the graduation class of an IDEAS cohort also touched on some of these themes. However I can also safely say that I have never put all of these ideas down in one place and further that this is by far the longest blog I have ever written. In fact, Pat Rich who helped me edit this said I should call this piece “The Long Goodbye”.

As a simple literary device I will bucket these ideas as “8 P’s”.

 

Challenges and opportunities: HQT 2018

by Dr. Joshua Tepper

It is only appropriate that the biggest conference in Canada, and one of the biggest in the world focused exclusively on health quality, should look with blunt honesty at the challenges of providing quality health care in 2018.

It is equally clear from listening and talking to the frontline health care professionals, patients, family members and others who made up the 3,000 delegates attending our Health Quality Transformation conference, that those present are willing to meet these challenges and uphold the six principles upon which quality care should be based - efficiency, timeliness, safety, effectiveness, patient-centredness and equity.

Quality Care: From Good to Great

Everybody wants quality health care. Why wouldn’t they?

This belief, which underpins the work of Health Quality Ontario, was recently endorsed by no less than the World Health Organization, World Bank and Organization for Economic Co-operation and Development Countries in a major report on global health care. They stated “even with essential health coverage and financial protection, health outcomes would still be poor if services were low-quality and unsafe”.

In a recent commentary in the CMAJ, we summarized data demonstrating that the quality of health care in Canada is good but not great. We also made several suggestions for improvement. In the article, we focused not on the things that individual clinicians could do differently, but rather on decisions that managers, administrators and policy makers can make. While most quality improvement initiatives are necessarily local, we feel certain key steps could be taken across the whole country.

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