North York General Hospital and MCC 360: Generating important conversations as part of Quality Improvement
North York General Hospital (NYGH) is one of Canada’s leading community academic hospitals and has been serving the diverse communities in North Toronto since 1968. The hospital partners with 36 different academic institutions, including the University of Toronto, to prepare future physicians, nurses, and other health care professionals to work in interprofessional teams to provide essential care in an academic community hospital setting. North York General is a top choice for University of Toronto medical students and residents in General Surgery, Medicine, Obstetrics, Emergency Medicine, and other disciplines.[i]
In 2019-20, the NYGH team saw 29,508 inpatients and 227,727 outpatients. As a learning organization, NYGH is committed to developing its people.[ii]
In 2014, NYGH had already begun assessing their physicians on critical skills outside of medical competence, such as communication, collaboration, and professionalism, as part of their Quality Improvement (QI) program. However, the approach varied from department-to-department. Each Program Lead conducted assessments differently, some utilizing existing surveys and others developing their own questions. Plus, with demanding schedules, completion of these assessments was often also an issue. Tracking each physician’s individual progress was time-consuming and as a result follow-ups to encourage completion were often inconsistent.
Choosing a multi-source feedback program
After looking for a tool that could provide more cross-department consistency for physician assessment, in 2019, NYGH became an early adopter of the MCC 360 program, offered by the Medical Council of Canada (MCC).
Dr. Donna McRichie, Vice President, Medical and Academic Affairs at NYGH, helped lead the MCC 360 implementation at NYGH. “One of the things that attracted me originally was the science behind some of these questions […] I was really quite impressed by the scientific merit and validity of the tool.”
The MCC 360 survey design, questions, reports, and program structure are based on existing research and new research by the MCC. All the survey questions undergo a psychometric review to ensure they assess and further develop physician performance in the CanMEDs roles of communicator, professional and collaborator. The MCC 360 program collects feedback from statistically valid cohorts of physician colleagues, non-physician co-workers and patients and collates responses into a customized, actionable report to be reviewed in a supported session.
A critical component of the MCC 360 program and its effectiveness, is one-on-one coaching based on the feedback contained in the report. As an academic teaching hospital, NYGH opted to have their Program Leads run these sessions, as educators and mentors.
Working with MCC 360
NYGH and the MCC 360 teams worked closely together to ensure the program fit NYGH’s needs and implement improvements to the program. One of the first enhancements made to MCC 360 was improved automation and structure for communications from the MCC 360 to participating physicians and nominated respondents. Compared to previous programs, Dr. McRichie explained that the MCC 360 “emails and messaging set expectations around completion and has been very, very valuable, as before we would have to do that ourselves.” Even though the communications put some pressure on participants, from an administrative perspective, NYGH found it improved completion rates while still allowing some flexibility for physicians by offering deadline extensions.
In addition, the MCC 360 program adapted to feedback from NYGH early on in their implementation on the exclusion of the patient feedback requirement for some specialities. It had become apparent that for some specialities it did not make sense to include a patient feedback requirement, such as for pathology or anesthesia, who may only have a mini-encounter of 10 minutes interacting with the patient. While the MCC 360 program recognizes the importance of patient feedback, this program adaption has ensured that the MCC 360 is relevant across specialities.
Consistently having important conversations
When implementing MCC 360, NYGH was looking for a tool to help bring consistency to physician assessment across the organization as part of their quality improvement program. Now, three years after the initial implementation, hundreds of NYGH physicians have completed the MCC 360 program. Approximately 95% of NYGH physician participants enrolled in the MCC 360 program have completed theirs as of February 2022. Even throughout the pandemic the median completion time was just 42 days. And, it is now standard process at NYGH that at the beginning of the year the number of physicians to complete the MCC 360 from each department is established with each Program Lead.
Beyond enhanced assessment consistency, the main benefit for NYGH of the MCC 360 program has been the high-quality conversations generated between participating physicians and their Program Lead. Dr. McRichie explained: “Consistency is one of the positives. It holds people to account in terms of our Chiefs and what the expectations are when they review their group members. But it’s also the conversation that gets generated by the Chief meeting with their members. It’s a springboard for additional conversations.” Conversations have touched on physicians’ teaching, careers and retirement plans as well as performance.
One of the other challenges the MCC 360 also helped address was adding a framework to report on the assessment and mentorship activities to the Hospital Board, Executive Team and stakeholders. Having a structured program has provided a standardized objective that demonstrates how the hospital is supporting its physicians and is accountable for the quality of care provided to patients as physicians.
Learn more about the MCC 360 program
MCC 360 is a national multi-source feedback program designed for physicians practicing in Canada to help develop their CanMEDS roles of communicators, collaborator and professional. The program focuses on the physician, helping them better understand their practice, including their strengths and areas of improvement by collecting feedback from colleagues, co-workers and patients and individualized one-on-one coaching. By completing the program, physicians can earn 12+ CPD credits with the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. The program is delivered by leaders in physician assessment, the Medical Council of Canada, and supported by a dedicated team and customer service agents. Learn more about the MCC 360 program.
[i] “Overview,” https://www.nygh.on.ca/about-us/overview (2022-02-23).
[ii] “Statistics and Area Served,” https://www.nygh.on.ca/about-us/overview/statistics-and-area-served (2022-02-23).