Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada
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Transcript of Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada
Which Way to Quality in Canada?
Health Care Quality Summit Regina, Saskatchewan
10 April 2013
Mark Dobrow, PhD
Director of Analysis & Reporting
• Intent to capture and share system-
wide approaches to quality
improvement across Canada from
the perspectives of senior health
system leaders
• Advisory panel with representatives
from provincial and national quality
agencies
• Interviewed senior leaders
• Surveyed federal, provincial and
territorial health ministries
Health Council’s latest report: Which way to quality?
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Context for QI in Canada Then and now
Then (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 agenda
Now
• Emerging (slowly) from global economic recession
• Canada continues to be at the middle or bottom of the pack relative to other
high 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 improvement
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The QI Journey Most have drunk the QI kool-aid
“Over the course of these 10 years we’ve really
started to segue from individual, organizational,
or health care setting approaches to a very
explicit province-wide intention around health
system quality”
“Quality improvement is going to be a series of
hard-fought and hard-won moves, both minor
and huge, that when all drawn together will
hopefully be a high-functioning system with
better outcomes. It’s not just flavour of the month
or the year.”
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• System alignment
• Dedicated quality agencies
• Capacity building
• Sharing and spreading best practices
• Legislation
• Measurement and accountability
• Leadership
• Evidence-informed care
• Patient/family engagement
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Foci of senior leaders
System alignment
“…we have a collectively owned health system strategic
plan. [It is] the expression of discussions involving font-
line workers, managers, and the leaders of all the regional
health authorities, the cancer agency, the ministry and a
number of other organizations, including the Health Quality
Council. [We have transitioned] to a health system plan
that says we have to think and act as one.”
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Dedicated quality agencies All collaborate, few investigate
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Dedicated quality agencies Kandinsky and the Health Council of Canada
Dedicated quality agencies Quality improvement roles
Dedicated quality agencies Many players, different roles
Capacity Building
• Leadership
• Important to foster a ’bottom-led, top-enabled’ approach.
• “ We saw many examples where teams became quite frustrated because they weren’t
being supported in the ways they needed to be, but I think it just came down to
knowledge and understanding and experience about what it means to actually support
this kind of work.”
• QI methods/science
• “You’ve got to build quality improvement capacity. You’ve got to have armies of people
out 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 a
system. That’s been a huge weakness, and a big part of our activities over the years is
trying to foster the development of that.”
• Change management
• “We don’t have the skills in the system to improve. We don’t have the change
management… so people may want to do that, but they don’t know actually how to fix
things.”
• Change fatigue: “…death by a thousand different improvement approaches…”
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Capacity building Change management…
12
Capacity building …change fatigue?!?
13
• 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/regional
needs
“I think there’s always been a big challenge with setting priorities, and I’ve
always been curious as to why the provinces can’t get more alignment on a
vision of what to improve and how to do it. We’re not that big a country to
be having 13 different strategies on how to improve health care.
Sharing and spreading
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Are we at a turning point? Fundamental Questions for System Leaders
1. Have we set a policy direction and developed a
system-wide strategy for quality improvement?
2. Are we confident that we are applying the best
possible approaches?
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3. 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 all
levels of the system—governmental, organizational, and clinical?
5. Is capacity-building a core part of our approach to QI, both to develop
leaders & train providers in QI methods?
6. Have we set clear goals and targets?
7. Who is accountable for quality improvement at the provincial, regional and
local levels?
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 Toronto
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www.healthcouncilcanada.ca