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DLSPH Blog – Why Quality Matters

September 26/2017

The DLSPH Blog is a digital platform that will explore issues that impact public health and health systems scholars on a biweekly basis written by Interim Dean Adalsteinn Brown in collaboration with DLSPH faculty, staff and students.
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A health-care system rooted in quality is one that is safe, effective, patient-centred, timely, efficient and equitable. For more than two decades, IHPME faculty, students and alumni have documented challenges and proposed solutions to achieving quality and ensuring patient safety. Their message is clear: a high-quality health system is one where all the moving parts — from the system to the individual level — are aligned with shared language, goals and values.

The IHPME community has contributed to Ontario’s quality framework through a series of milestones, including: the introduction of the concept of balanced scorecards in Canadian hospitals in 1995 and the realization of the scorecard for Ontario acute care hospitals in 1998, the Canadian Adverse Events Study published in 2004, and the Quality by Design book published in 2008 that provided case studies of high performing healthcare systems. We are a hub for building skills and knowledge in quality improvement and patient safety: a number of our graduate programs are built on the foundations set by these reports, including IDEAS, the MSc QIPS and the MHSc in Health Administration.

Given these advancements in quality improvement, how is Canada’s health-care system performing?

In the Mirror, Mirror 2017 report published earlier this summer by the Commonwealth Fund, Canada ranked ninth — ahead of only France and the bottom-ranked United States — in a study that compared health-care system access, equity, outcomes and administrative efficiency in 11 developed nations. Canada’s system ranked below average due to its comparatively higher infant mortality rate, the prevalence of chronic conditions, long wait times in emergency rooms and to see specialists, poor availability of after-hours care, and a lack of reliable coverage for dental care and prescription drugs.

There are still many gaps and challenges and there is no easy fix, but Health Quality Ontario believes the reason is because the Ontario health-care system only works well for some people, with some conditions, treated in some institutions, at some points in time. They call this situational quality, not systemic quality, and have developed a robust strategy to improve system quality in the province.

To develop their strategy, Health Quality Ontario struck a series of working groups that included a number of DLSPH faculty members to create a set of recommendations around understanding quality, delivering quality care, and fostering a culture of quality. Their work was published earlier this spring in Quality Matters: Realizing Excellent Care for All, a practical report about how to build health quality in Ontario.

Delivering on Health Quality Ontario’s vision isn’t easy and it requires joined up action at the regional, agency, institutional and individual level, but our community has been at the forefront of solutions for decades. Our faculty hold leadership roles across the province, and we have an excellent foundation on which to build outlined in the Excellent Care for All Act, the Patients First Act, and many more.

But delivering quality care isn’t just the responsibility of government. It’s everyone’s responsibility to improve their one-on-one interactions with patients, providers, policy-makers, and help create a culture of quality.

In the coming weeks, members of our community will be attending Health Quality Transformation (HQT) and participating in Change Day Ontario, two opportunities to learn, network and grow together around the message that quality matters. Whether your focus is patients, communities or the entire health system, it’s up to all of us to improve system quality, and make Canadians healthier.

– Professor Adalsteinn Brown, Interim Dean, Dalla Lana School of Public Health & Dalla Lana Chair of Public Health Policy, in collaboration with Michelle Rossi, Director, Policy and Strategy at Health Quality Ontario and Ross Baker, Professor of Quality Improvement and Patient Safety at IHPME.