Minding the gaps in quality improvement in Canadian healthcare

What can Canada gain by upping its investment to advance the health quality improvement (QI) agenda? And, in what areas should it invest? A lot, in my opinion; and the focus needs to be on increasing the capability and capacity of our system and its leaders to deliver transformative change.  On October 29 and 30, 2013, the Health Council of Canada hosted a National Symposium on Quality Improvement – Towards a High Performing Health Care System: The Role of Canada’s Quality Councils.  The forum provided an opportunity for 200 senior leaders from across Canada to discuss health system performance measurement and reporting, as well as the need to build capacity and capability for quality improvement.

The symposium highlighted the work of the provincial health quality and patient safety agencies in these respective areas, and explored opportunities for further inter-provincial collaboration on quality improvement. The event stressed the need to increasingly think and act as one, if we [Canada] want to optimize the quality of health care for all Canadians. It was clear from discussions that there is no ‘one size fits all’ when it comes to performance measurement or reporting and each jurisdiction with a quality and/or patient safety organization (there are seven in total) have adopted approaches that are working for them.

So what are the gaps in Canada’s current quality improvement approach that need to be closed? And how do we achieve transformative change?

The first gap is the absence of a burning platform for transformative change so that quality improvement is embedded in everything we do in healthcare. Are health leaders and Canadians themselves convinced that we need to improve the quality of the care being delivered in each hospital, clinic and doctor’s office in this country? The evidence says we need to, but is that enough to make the case?

The second gap or challenge is treating QI as an add-on. Shouldn’t our health system encourage all its leaders to begin their day with the question: What have we got to do today to ensure all our activities deliver safe and appropriate care for our patients; and end their day by asking:  how do we know that we achieved this objective?

If QI is its own silo, we are not going to achieve transformative change in any setting. Dr. Jack Kitts, Chair of the Health Council of Canada and CEO of the Ottawa Hospital is leading a collaborative initiative involving 12 of Canada’s teaching hospitals to narrow down indicators for safe and appropriate care, among other activities related to quality care. According to Dr. Kitts, “If individual hospitals or organizations continue to look only at their own performance, quality improvement will remain fragmented. In this collaborative, we are working to reach agreement on a select number of indicators that we will report publicly. These indicators will not only allow the public to assess the performance of individual hospitals, they will allow us to compare performance across Canada, and learn from each other in the process. Joining forces like this is just a start to putting QI into the arena of transformative change. While it is still a work-in-progress, I am learning that identifying where you want your system to go and getting there are two different things. One thing is clear: without leadership and a commitment to improvement we won’t get there.”

The third gap relates to resources. We need to increase the level of investment in resources to successfully design and manage a QI agenda. We need to train people at the front lines and in the back rooms to think as one, using a common language around performance improvement. We need to continually support the work of quality councils in this country who in turn are aligning their activities in support of the health systems that they both monitor and engage on quality improvement initiatives. A fourth gap is not appreciating the magnitude of managing complex system change.

Several provinces have recently launched new initiatives to equip front line staff and leaders with the skills to manage complex changes across the system. I draw on Saskatchewan as likely the most advanced example of system-wide change management. The government and the Health Quality Council of Saskatchewan have committed to ensuring every one of the 40,000 people who work in healthcare there has at least one day of Kaizen training. In Saskatchewan, this has taken QI ‘off the side of the desk’ and put it squarely on everyone’s agenda.

A fifth gap lies in the area of technology and information sharing. We need to leverage the use of today’s technology to collect data and share information about system performance and patient outcomes in a consistent and timely way that can be used by all parts of the system to improve the quality of care. No one organization or system has all the answers to addressing these gaps. All in all, we need to collaborate within and across organizations and jurisdictions to build capacity and capability in all these areas. The Health Council’s report on the proceedings of its event will cover these points in greater detail and will be released on December 16, 2013 at www.healthcouncilcanada.ca.