Embracing change and quality improvement

I have worked at St. Michael’s Hospital for more than 30 years, first as a practising physician, then on the executive team, and now as CEO, and I have seen many changes.

I thought I would take this opportunity to reflect on the quality journey at St. Michael’s Hospital, which is all about change. We have defined quality under six key dimensions: safety, outcomes, access, patient experience, equity and efficiency. All of us in healthcare need to advocate for finding better ways to care for all who come to us in need. We stay at the top of our game only if we work at it every hour of every day.

As the health care budget has grown as a percentage of the provincial budget, the level of scrutiny of hospitals has expanded greatly. The Excellent Care for All Act requires boards to have Quality Committees and hospitals to file annual quality improvement plans, among many other things.

And, as increased funding restraints come into play, hospitals will be constantly challenged to provide higher quality care at lower costs. High quality care is indeed less expensive care. By keeping our patients safe, by avoiding complications, hospital-acquired infections, falls etc., we actually save money for the system.

By standardizing care we also make care safer, improve our outcomes, improve the patient experience and again, save money. By working at the transitions of care or handoffs when opportunities for mistakes are highest, we once more make our hospital safer, patients happier, improve patient flow and outcomes and again, reduce costs.

We are challenged by government to participate in improving the systems of care for the patients of the province. No one organization can provide high quality care in isolation from the rest of the system. Therefore, we need to continue to develop partnerships with all those institutions and agencies that relate to our patients, such as rehabilitation and complex continuing care hospitals, long term care facilities, community care access centres and all of the shelters and health care agencies with which we interact.

Perhaps, most importantly, we will have to pay particular attention to the primary care system, in our case, the five family health teams supported by St. Michael’s, which work in the community to serve many of the same patients who come in and out of the hospital. One of our key quality indicators for 2012/13 will be our compliance with providing the family physicians with our discharge summaries.

We continue to ask our staff to find more efficient ways to do their work so that we can reduce costs. We will continue to implement models of care and strategies which have been proven in other jurisdictions to improve quality of care.

For example, I am very proud that every surgical service at St. Michael’s Hospital has now achieved 100 per cent compliance with the internationally-validated surgical check list, designed to reduce the possibility of error in the operating room.

But more than this, as an academic hospital we are involved in care innovations. This means that we will invent new approaches which we will test and if proven to be effective, implement.  Almost certainly, these innovations will also result in care that is less costly.

Our Foundation, through a unique matching gift from an anonymous donor, helps us fund a Quality Innovation Fund that supports innovative approaches to quality.

One of our surgeons used this fund to develop the minor surgery or day surgery equivalent of the surgical check list. The new check list is now being piloted here and, if proven effective, may reduce the potential errors in another high volume part of our hospital.

The culture of healthcare must continue to evolve. Health care professionals need to constantly upgrade their knowledge and skills in the techniques of quality improvement. We need to do this across the system so that we develop a culture that embraces change and quality improvement. I am confident that health care staff already understand that there is no limit to better and that we are all on a journey that includes continuous improvement in everything that we do.