Which Way to Quality in Canada?

Health Care Quality Summit Regina, Saskatchewan

10 April 2013

Mark Dobrow, PhD

Director of Analysis & Reporting

• Intent to capture and share system-

wide approaches to quality

improvement across Canada from

the perspectives of senior health

system leaders

• Advisory panel with representatives

from provincial and national quality

agencies

• Interviewed senior leaders

• Surveyed federal, provincial and

territorial health ministries

Health Council’s latest report: Which way to quality?

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Context for QI in Canada Then and now

Then (i.e., at the time of the 2003/04 health accords)

• Emerging from period of tight fiscal constraint

• Concern about quality and wait times

• Numerous health system reviews (e.g., Fyke, Mazankowski, Kirby, Romanow)

• New federal funding central to reform agenda

Now

• Emerging (slowly) from global economic recession

• Canada continues to be at the middle or bottom of the pack relative to other

high income countries on many health system performance indicators

• New/predictable federal funding model for health care

• Growing consensus that more funding is not the answer

• Growing acknowledgement of the business case for quality improvement

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The QI Journey Most have drunk the QI kool-aid

“Over the course of these 10 years we’ve really

started to segue from individual, organizational,

or health care setting approaches to a very

explicit province-wide intention around health

system quality”

“Quality improvement is going to be a series of

hard-fought and hard-won moves, both minor

and huge, that when all drawn together will

hopefully be a high-functioning system with

better outcomes. It’s not just flavour of the month

or the year.”

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• System alignment

• Dedicated quality agencies

• Capacity building

• Sharing and spreading best practices

• Legislation

• Measurement and accountability

• Leadership

• Evidence-informed care

• Patient/family engagement

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Foci of senior leaders

System alignment

“…we have a collectively owned health system strategic

plan. [It is] the expression of discussions involving font-

line workers, managers, and the leaders of all the regional

health authorities, the cancer agency, the ministry and a

number of other organizations, including the Health Quality

Council. [We have transitioned] to a health system plan

that says we have to think and act as one.”

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Dedicated quality agencies All collaborate, few investigate

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Dedicated quality agencies Kandinsky and the Health Council of Canada

Dedicated quality agencies Quality improvement roles

Dedicated quality agencies Many players, different roles

Capacity Building

• Leadership

• Important to foster a ’bottom-led, top-enabled’ approach.

• “ We saw many examples where teams became quite frustrated because they weren’t

being supported in the ways they needed to be, but I think it just came down to

knowledge and understanding and experience about what it means to actually support

this kind of work.”

• QI methods/science

• “You’ve got to build quality improvement capacity. You’ve got to have armies of people

out there who understand Lean Six Sigma or process improvement or Plan-Do-Study-

Act cycles or rapid cycle improvement or who really can understand and pick apart a

system. That’s been a huge weakness, and a big part of our activities over the years is

trying to foster the development of that.”

• Change management

• “We don’t have the skills in the system to improve. We don’t have the change

management… so people may want to do that, but they don’t know actually how to fix

things.”

• Change fatigue: “…death by a thousand different improvement approaches…”

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Capacity building Change management…

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Capacity building …change fatigue?!?

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• Eclectic mix of system-wide approaches to QI across the country.

• No consensus on which approaches are better/worse

• A need for more evaluation of Canadian approaches

• Desire to learn more about others’ successes

• Don’t reinvent the wheel – we need to ‘…beg, borrow, and steal shamelessly.”

• But one size doesn’t fit all – we need to become better at adapting to local/regional

needs

“I think there’s always been a big challenge with setting priorities, and I’ve

always been curious as to why the provinces can’t get more alignment on a

vision of what to improve and how to do it. We’re not that big a country to

be having 13 different strategies on how to improve health care.

Sharing and spreading

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Are we at a turning point? Fundamental Questions for System Leaders

1. Have we set a policy direction and developed a

system-wide strategy for quality improvement?

2. Are we confident that we are applying the best

possible approaches?

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3. Does our QI approach cover all sectors of the health care system?

4. Who are the QI leaders and do we have a plan to develop leadership at all

levels of the system—governmental, organizational, and clinical?

5. Is capacity-building a core part of our approach to QI, both to develop

leaders & train providers in QI methods?

6. Have we set clear goals and targets?

7. Who is accountable for quality improvement at the provincial, regional and

local levels?

Please check out:

• Health Innovation Portal • www.healthcouncilcanada.ca/innovation

• Launched in November 2012

• 350+ innovative practices in the searchable database (~25 from SK)

• Always seeking new submissions!

• 2013 National Symposium on Quality Improvement • Hold the date: 29-30 October 2013 in Toronto

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www.healthcouncilcanada.ca

mdobrow@healthcouncilcanada.ca