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Dr. Joshua Tepper

Quality Still Matters

“If you don’t know where you are going, any road will take you there,” says the Cheshire Cat in Alice in Wonderland.

That view is shared by many involved with bringing quality to health care. Everyone felt quality was important but what it meant and how to get there was much more elusive – especially at the system level.

It was for this reason that more than a year ago, through the work of the System Quality Advisory Committee, Health Quality Ontario introduced Quality Matters –an attempt to create a common playbook for advancing quality in the provincial healthcare system.

Quality Matters provided a definition of system-wide quality, a vision for the health care system, and a set of principles to guide it—essentially, a common understanding of what quality-first health care looks like.

But we knew that more needed to be done. Ontario still does not have a high quality, healthcare system for everybody and the health system only works well for some people, with some conditions, treated in some institutions some of the time.

Health Quality Ontario is now sharing the second phase of the System Quality Advisory Committee’s work: recommendations on how to build quality at the core of our health care system in Ontario.

These recommendations come from three working groups created by the committee to look more deeply into the issues of understanding quality health care, delivering that care and fostering a culture of quality.

Understanding quality care

Measurement was seen by the working group as a key objective for understanding quality care with equity being seen as an essential element of every quality measure.

Recommendations from this group include:

  • Health care organizations ensure people working within their institutions are capable of understanding data and using it for improvement.
  • Organizations that hold and share data ensure providers have access to information needed to benchmark the quality of care, design improvement projects and support patient engagement.

Delivering quality care

The working group responsible for this area felt alignment, accountability and leadership are the three foundational pieces that support the delivery of quality health care.

To bring quality to health care delivery there must be a clear articulation of who is responsible for what to ensure patients fully benefit from high quality care and there must be resolute leadership focused on improving everyone’s quality of care.

Recommendations made by this group include:

  • The Ministry of Health and Long-Term Care, professional colleges and associations, health care organizations, agencies and their boards ensure quality improvement is clearly understood as a critical component of the role of all care providers.
  • Health care organizations and agencies adopt the Quality Matters framework as the basis for strategic planning and accountability efforts. Improved delivery of health care services means achieving better value, better patient outcomes and better patient and provider experience.

Fostering a culture of quality

To foster a culture of quality, the working group felt a goal should be that patients, caregivers and providers are committed to a culture of quality that is fuelled by continuous learning from experiences of those who provide and receive care. They also felt there should be a system-wide culture of quality with an unyielding commitment to improvement.

Recommendations here include:

  • Health care organizations contribute to transparent reporting and resolution of patient complaints and concerns.
  • Health care providers and other frontline leaders share both successes and failures as part of an overall commitment to improving the quality of patient care and experience.

The three working groups feel their recommendations are actionable, measureable, and achievable and do not require a significant influx of funding.

Work on these could start today, and in some places is already happening. Major progress could be achieved within the next five years.

The recommendations call on health care stakeholders, from providers to the Ministry of Health and Long-Term Care and Health Quality Ontario itself, to work together and take these concrete steps to deliver tangible improvements in quality care.

With a good roadmap and a clear sense of direction we can now envisage moving forward, past situational quality and towards systemic quality – to provide better care in a sustainable health care system.

We are considering how we, at Health Quality Ontario, can contribute to furthering the goals set out in the report, and we’ll be reaching out to leaders across the system to talk more about it in the weeks and months ahead.

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2 comments on article "Quality Still Matters"

Wendy Nicklin

The work of the System Quality Advisory group and the Working Groups is to be commended. The recommendations are sound and comprehensive. While still a long way to go, we are all on this journey together. Focus, commitment and definitive action with strong leadership are key. Well done HQO!

Joshua Tepper

Thanks so much Wendy for your support and acknowledgement!


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