Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada


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Pre-summit workshop on Wedesday, April 10 at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.

Learn more about quality improvement from the perspectives and experiences of Canada’s senior health care leaders. Recently, the Health Council of Canada interviewed these leaders and surveyed governments about their quality improvement efforts across federal, provincial and territorial health care systems. This presentation provides insight into the wide range of system-level quality improvement approaches across the country as well as the success factors and barriers to change. It also provides an overview of the many innovative quality improvement initiatives taking place across the country.

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Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada

  1. 1. Which Way to Quality in Canada?Health Care Quality SummitRegina, Saskatchewan10 April 2013Mark Dobrow, PhDDirector of Analysis & Reporting
  2. 2. • Intent to capture and share system-wide approaches to qualityimprovement across Canada fromthe perspectives of senior healthsystem leaders• Advisory panel with representativesfrom provincial and national qualityagencies• Interviewed senior leaders• Surveyed federal, provincial andterritorial health ministriesHealth Council’s latest report:Which way to quality?2
  3. 3. Context for QI in CanadaThen and nowThen (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 agendaNow• Emerging (slowly) from global economic recession• Canada continues to be at the middle or bottom of the pack relative to otherhigh 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 improvement3
  4. 4. The QI JourneyMost have drunk the QI kool-aid“Over the course of these 10 years we’ve reallystarted to segue from individual, organizational,or health care setting approaches to a veryexplicit province-wide intention around healthsystem quality”“Quality improvement is going to be a series ofhard-fought and hard-won moves, both minorand huge, that when all drawn together willhopefully be a high-functioning system withbetter outcomes. It’s not just flavour of the monthor the year.”4
  5. 5. • System alignment• Dedicated quality agencies• Capacity building• Sharing and spreading best practices• Legislation• Measurement and accountability• Leadership• Evidence-informed care• Patient/family engagement5Foci of senior leaders
  6. 6. System alignment“…we have a collectively owned health system strategicplan. [It is] the expression of discussions involving font-line workers, managers, and the leaders of all the regionalhealth authorities, the cancer agency, the ministry and anumber of other organizations, including the Health QualityCouncil. [We have transitioned] to a health system planthat says we have to think and act as one.”6
  7. 7. Dedicated quality agenciesAll collaborate, few investigate
  8. 8. 8Dedicated quality agenciesKandinsky and the Health Council of Canada
  9. 9. Dedicated quality agenciesQuality improvement roles
  10. 10. Dedicated quality agenciesMany players, different roles
  11. 11. Capacity Building• Leadership• Important to foster a ’bottom-led, top-enabled’ approach.• “ We saw many examples where teams became quite frustrated because they weren’tbeing supported in the ways they needed to be, but I think it just came down toknowledge and understanding and experience about what it means to actually supportthis kind of work.”• QI methods/science• “You’ve got to build quality improvement capacity. You’ve got to have armies of peopleout 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 asystem. That’s been a huge weakness, and a big part of our activities over the years istrying to foster the development of that.”• Change management• “We don’t have the skills in the system to improve. We don’t have the changemanagement… so people may want to do that, but they don’t know actually how to fixthings.”• Change fatigue: “…death by a thousand different improvement approaches…”11
  12. 12. Capacity buildingChange management…12
  13. 13. Capacity building…change fatigue?!?13
  14. 14. • 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/regionalneeds“I think there’s always been a big challenge with setting priorities, and I’vealways been curious as to why the provinces can’t get more alignment on avision of what to improve and how to do it. We’re not that big a country tobe having 13 different strategies on how to improve health care.Sharing and spreading14
  15. 15. Are we at a turning point?Fundamental Questions for System Leaders1. Have we set a policy direction and developed asystem-wide strategy for quality improvement?2. Are we confident that we are applying the bestpossible approaches?153. 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 alllevels of the system—governmental, organizational, and clinical?5. Is capacity-building a core part of our approach to QI, both to developleaders & train providers in QI methods?6. Have we set clear goals and targets?7. Who is accountable for quality improvement at the provincial, regional andlocal levels?
  16. 16. 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 Toronto16
  17. 17. www.healthcouncilcanada.camdobrow@healthcouncilcanada.ca