Quality Conference 2014 Overview


Quality Conference 2014: Sustaining Success!



Underscoring the importance of Sustaining Success!  

Health care executives, managers, and front-line staff attended the 3rd annual Accreditation Canada Quality Conference to learn about initiatives that positively impact health care. In keeping with its reputation, the conference featured first-rate content on innovation in quality improvement approaches and ways to sustain these initiatives. This conference linked attendees with knowledge sharing about some of the country’s most dynamic and effective examples of quality improvement initiatives.

The two-day program was packed with educational activities that kept everyone busy listening to inspirational presentations, interacting in workshops, visiting exhibits, browsing poster displays, networking with colleagues, and celebrating the Leading Practices award recipients’ successes...

… and there was still time for fun!  


April 10 and 11, 2014  Hilton Lac-Leamy, Gatineau, QC












If you missed this year’s event, make sure you’re at the 2015 Quality Conference in Toronto.

Early bird registration is now open.  


The program featured topics promoting safety, quality of care, and innovation. To read the presentation summaries, click on a session title. Summaries of keynote presentations are available in English and French; workshop summaries are available in the language of delivery.

Friday, April 11: Day 2

Opportunities and tensions to improve quality in Ontario

Dr. Joshua Tepper — President and CEO, Health Quality Ontario

Coach, console, or discipline? Implementing a Just Culture to improve patient safety

Sharon Morris — Director, Human Resources & Labour Relations, Windsor Regional Hospital

Workshops Round 3 

  1. Leading the way: How an organization’s leadership promotes least restraint in a Canadian psychiatric hospital
  2. Le tableau de bord qualité, un gage de transparence et de confiance
  3. Patient-centered care
  4. Web-based learning to improve patient-centered care

The Big Q: What does "quality" mean to a patient?

André Picard — Journalist, The Globe and Mail

Workshops Round 4 

  1. Sécurité des services et gouvernance
  2. Improving First Nations’ client experience from hospital to home
  3. Medication reconciliation in home care: Sharing our process and strategies 
  4. Building a culture of collective accountability to prevent never events and keep patients safer in the community

The Denouement: Untangling the relationship between suicide, data analytics, social media, and proactive mental health care

Shelley McKay — Patient Advocate and Strategic Risk Management Consultant

Rapid fire panel — The patient experience

  1. Time for change: Engage and empower patients and families 
  2. Using a quality improvement approach to improve the patient experience in partnership with patients
  3. An evidence-based approach to partnering with patient and family advisors on quality councils 
































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An evidence-based approach to partnering with patient and family advisors on quality councils
Michelle Joyner, Director, Strategic Planning, St. Joseph’s Healthcare Hamilton

St. Joseph’s Healthcare Hamilton (SJHH) is a 691 bed, multi-site, academic health science centre in HNHB LHIN, ON. Staffing is comprised of 4,000 staff and 550 physicians committed to providing exceptional care; however, the perception of the meaning of PFCC care was inconsistent as evidenced from staff focus group interviews carried out to determine their valuing of patient inclusion in groups.

The initiative was guided by Kotter’s change model and was part of the Canadian Foundation for Healthcare Improvement EXTRA/FORCES fellowship program. A Sense of Urgency was created by the literature highlighting the benefits of PFCC, and SJHH's Board and Executive were strongly committed. A Powerful Coalition was formed by strategically presenting the evidence around PFCC to key groups to gain organizational support. A clear Vision was defined for all stakeholders: Implementation of evidence based approach to actively engage our patients and families to: 1) Improve quality and patient safety 2) Advise on hospital policies, programs, and planning 3) Share their patient story. Obstacles were removed, including perceived limitations of involving patients on councils (i.e., "it will slow us down”). A robust recruitment, orientation, and peer support process was provided to advisors and all QC staff and advisors received education based on their learning needs identified from the initial focus groups, to facilitate meaningful engagement. Three-month follow-up phone calls, a buddy system and post one-year focus groups were held.

Short Term Wins: A shift in culture occurred with an increase in staff requests for advisors to collaborate on initiatives and sit on committees; there was a statistically significant increase in collaboration on QCs (Assessment for Interprofessional Collaboration Scale); and SJHH recruited 31 Patient/Family Advisors to 14 QCs.

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Bridgepoint's journey to transform care for complex patients
Marian Walsh, President and CEO, Bridgepoint Active Healthcare

The burden of multiple (or complex) chronic conditions is often complicated by poor social determinants of health. This is the new, uncharted frontier of health care.

Across Canada, the majority of people over age 65 live with two or more chronic diseases; over one quarter of them live with four or more. One in four overnight hospital visits is from a complex patient, and each of these visits is about three times as expensive as a visit for someone without chronic conditions.

Bridgepoint Active Healthcare is a hospital, a primary care practice, and a research centre. Its innovation “collaboratory” has a unique focus on complex chronic diseases.

To understand this population’s unique needs, Bridgepoint examined its own population, and took a retrospective look at how some patients became “complex” in the first place. This work came to be known as The Bridgepoint Study. Its results have informed a new model and approach to care at the patient and the system level.

At the centre of the Bridgepoint model is a 360-degree assessment and care plan, with the patient at the centre, and an inter-professional team aligned with the plan organized around the patient’s needs.

Managing complexity is the next frontier for health care, and it needs to be considered within quality and system reform as well as policy, research, and education.

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Building a culture of collective accountability to prevent never events and keep patients safer in the community
Deborah Gollob, Project Manager, Organizational Health and Performance Improvement, Central Community Care Access Centre

The Central Community Care Access Centre (CCAC) is working to improve patient care and safety through Never Events education focused on building an organizational culture where everyone plays a role in preventing medication errors.

Never Events are serious, preventable, reportable incidents that should never happen to patients in a health care setting. Central CCAC sponsored ground-breaking University of Toronto research that identified 30 home care Never Events and recommendations to support successful reporting and quality improvement.

With staff and service provider input, Central CCAC focused first on serious medication-related errors resulting in emergency department visits or hospitalization.

Between June and September 2013, Central CCAC held 30 Never Events workshops and webinars. Over 580 CCAC staff, management, and service providers from 16 organizations discussed real cases and connected research principles to their roles.

Participants said they learned the value of collaboration in preventing medication errors. 98% said they were committed to applying what they learned to their work.

Post-education, the number of ideas submitted by staff for process improvements related to medication errors has increased, and there has been an upward trend in error reporting, which was encouraged by Central CCAC as a means to improve care by focusing on solutions.

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Coach, console, or discipline? Implementing a just culture to improve patient safety
Claudia den Boer Grima, Vice President, Regional Cancer and Clinical Support Services for the Windsor Regional Hospital, and Regional Vice President of the Erie St. Clair Regional Cancer Program, Windsor Regional Hospital
Sharon Morris, Director, Human Resources & Labour Relations, Windsor Regional Hospital

Health care leaders and managers are focused on the creation of cultures that will embed safety in all elements of the health care environment. A key element in transforming the culture is clarifying the accountability of both leaders/managers and all employees. The Just Culture Framework has been recognized as a methodology to guide this transformation. This framework promotes accountability within a supportive climate and helps ensure that patients are protected from harm. It’s about accountability for the systems that are designed, and the choices (behaviours) we make within those systems.  Algorithms guide the process and align the appropriate response based on the nature of the incident. 

This presentation describes the implementation of a Just Culture Framework at our hospital and its implications for patient safety, accountability, and employee satisfaction. It outlines the challenges of determining when to console, to coach, or to discipline employees when an adverse event occurs. There will also be discussion about the accountability of all staff and special considerations required when implementing in a unionized environment.The application of the Just Culture Framework is illustrated using actual quality improvement initiatives.

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COPD integrated care pathway at Seven Oaks General Hospital
Rose Dziadekwich, Manager, Education Services, Seven Oaks General Hospital
Ken Grove, Director, Rehabilitation Services, Seven Oaks General Hospital

The COPD Integrated Care Pathway demonstrated an effective model for standardizing care for better patient access and outcomes, and dramatic improvements in health system efficiency. Acute, primary and community partners collaborated on pathway tools to govern the patient journey and standardize care. The project shows the way forward for permanent change in the way COPD care is delivered.

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Improving First Nations’ client experience from hospital to home
Shubie Chetty, Senior Nurse and Quality Consultant, First Nations and Inuit Home and Community Care Program

Many First Nation (FN) clients who return to their home after a hospital stay do not have their care needs communicated to Band-employed nursing staff by discharge planners, because no such protocols exist. Moreover, discharge planners and provincial home care providers are generally unaware of the service capacities and gaps in First Nation communities. As a consequence, care plans are either not developed or could be better informed. This lack of coordinated discharge and care planning may also lead to unnecessary long waits in hospital, avoidable readmission and complication rates with obvious impacts on the broader health care system, patients and families. The aim is to better understand the unique needs of FN clients’ returning to home community from provincial hospitals and finding ways to improve safe handoff of care resulting in seamless service.

Key issues: To raise awareness of unique discharge planning needs for FN living on reserve; to facilitate communication and continuity of care between hospital and First Nations Home and Community Care; and improve collaboration.

Method: Showcasing a First Nations Home and Community Care Discharge Toolkit used to improve communication, collaboration, and discharge planning and to outline the experiences and lessons learned.

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Improving hand hygiene through front line ownership
Debbie Davidson, Infection Control Practitioner, Cape Breton District Health Authority
Ann Buchanan, Unit Manager, Cape Breton Regional Hospital

In 2011, the Cape Breton District Health Authority (CBDHA) endured two clostridium difficile outbreaks with 191 patients testing positive for the organism with the unfortunate result of 15 deaths. CBDHA received an Auditor General’s review accompanied by recommendations from Infection Prevention and Control Nova Scotia. There were 57 recommendations which initiated vast media coverage. These recommendations enabled the district to move forward with innovative initiatives to implement and increase patient safety.

CBDHA knew that having two clostridium difficile outbreaks was detrimental, but how could we learn from this experience and move forward? One key area of improvement was the implementation of a hand-hygiene program for all health care providers. The measurement of success has been determined through the development of an extraordinary Infection Control database. The database allows for district specific reporting and real time auditing, which can be evaluated by health care providers, units and facilities within CBDHA. A second measurement of success was seen through a pilot program which engaged staff in frontline ownership. This was done on two medical units at the Cape Breton Regional site.

How did CBDHA do this? The pilot units were able to develop their own hand-hygiene initiatives, where a trophy was presented to the unit with the highest compliance rate at the end of the month. This evoked competition and goal directed behavior though engagement and knowledge. The reviews and recommendations were the spark that facilitated CBDHA to work towards performance excellence in Infection Prevention and Control through culture change.

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Improving quality and safety through transparency and accountability – Jewish General Hospital quality improvement web indicators 
Markirit Armutlu, Quality Program Coordinator, Jewish General Hospital

The Jewish General Hospital has embarked on a program initiated in 2010 and officially rolled out in July 2011 to give public exposure to performance measures and related quality and safety improvement activities.   

These performance measures, providing timely, clear and understandable information, are known as Quality Indicators and are now posted on the JGH web-page. We hope that by giving Quality Indicators such wide exposure, the program will serve as a model for other hospitals in Quebec. In this way, health care consumers will have a better understanding of how much is being done on their behalf by clinical teams to improve safety and quality of care at the JGH and, ultimately, in hospitals across Quebec.

Each of the indicators presented have a written text defining the indicator and the quality improvement team activity associated with it. The performance data for the year as well as trending data over past years is included in addition to our targets, presented in tabular and/or graphic form. In addition, each indicator page has a video clip with the clinical expert speaking on the interdisciplinary quality and safety improvement activities associated with the indicators. This is unique and the first of its kind in Québec.

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Keeping score – Using physician scorecards to drive and sustain quality
Jatinder Bains, Ambulatory Manager, Rouge Valley Health Systems

The introduction of a physician score card is nothing new. The use of the scorecard to get major quality and operational performance improvements and sustain this is something that deserves to be shared.  This presentation shares strategies that were used in addition to the quarterly distribution of a physician performance report to achieve a regional success story.

While many organizations are struggling in this competitive field and many are closing endoscopy rooms, we have increased our efficiency, customer service and market share. The Endoscopy unit at Rouge Valley Health System has gone from an average performer in the Central East Local Health Integration Network (LHIN) to the leader in many important metrics. The scorecard focuses on efficiency, wait times and a number of clinical outcome measures. The team at the Digestive Diseases Unit (DDU) has leveraged change management, innovation, Lean principles, strategic planning and team engagement to create a highly efficient and focused program. The score card is a highly anticipated quarterly touch-base point!

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Leading the way: How an organization's leadership promotes least restraint in a Canadian psychiatric hospital
Patrick Griffith, Chief Nursing Officer and Vice President, Health Sciences Centre, Winnipeg; Assistant Professor, Nursing, University of Manitoba

There is strong evidence in the literature to support the use of seclusion reduction initiatives on acute mental health units (Cadeyrn, Gaskin, Stephen, Elsom, & Happell, 2007). It is also recognized that the leadership team of an organization plays a key role in achieving the goal of least restraint (Waqar Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2011). Our drive to effectively and efficiently reduce incidents of aggression and maintain the safety of patients and staff in health care, specifically in high risk areas is highlighted in this presentation. We share strategies of how an organization’s leadership team can support a philosophy of least restraint and share the challenges of implementing seclusion and restraint initiatives.

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Le tableau de bord qualité, un gage de transparence et de confiance
Chantal Bouchard, Professeure en sciences de la consommation, spécialisée en gestion de la qualité des services, Université Laval
Anne Simar, Directrice adjointe du CSSS du haut St-François

Les établissements de santé sont conviés à la transparence et à une reddition de comptes accrue, lesquelles leur posent un défi constant.  Plusieurs facteurs rendent quelquefois « ardus » les différents suivis qui doivent être faits par les instances d’un CSSS et ses gestionnaires.  Les recommandations émises par divers comités légalement mandatés par le conseil d’administration ou encore par des organismes externes avec lesquels les établissements transigent au quotidien doivent bénéficier d’un suivi approprié pour susciter la confiance et le soutien aux changements qui sont apportés.  La question se pose également sous l’angle de la planification stratégique d’un établissement voulant rendre compte de ses avancées aux membres de son organisation, ses partenaires et la population du territoire. Comment, plus spécifiquement dans les petites organisations, peut-on se doter d’un moyen simple pour assumer pleinement cette responsabilité de rendre compte des engagements pris sous ces deux angles?  Le tableau de bord qualité s’avère un outil incontournable mais celui-ci doit demeurer accessible, compréhensible et parlant pour les publics cibles.

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L’expérience patient : lorsque le rationnel rencontre l’émotion
Sylvie Provost, Directrice de la qualité, CSSS Richelieu Yamaska

Depuis plus d’un an, le  CSSS Richelieu Yamaska s’est engagé à ce que l’expérience client soit au cœur de ses préoccupations. Par des visites hebdomadaires de la directrice générale, accompagnée du directeur et du gestionnaire concernés, les patients rencontrés peuvent discuter de leur expérience et fournir des pistes d’amélioration en mettant l’accent sur la perspective du patient. Le partage ouvert de l’information contribue à renforcer la confiance entre les patients et les équipes de soins. Ces communications améliorent aussi la sécurité et l’expérience des soins.

Le suivi de ces rencontres se fait en comité de direction où des décisions sont prises. Au besoin, un traceur d’une trajectoire de soins est effectué pour comprendre une situation complexe. Chaque visite patient constitue un levier et permet une grande agilité à l’organisation pour l’identification et l’implantation rapide d’initiatives d’amélioration, lesquelles font une différence sur le terrain. En plus d’améliorer rapidement la qualité au quotidien, ces visites hebdomadaires indiquent clairement dans l’organisation que l’expérience patient est une priorité absolue.

Dans le cadre d’un atelier, la directrice générale et la directrice de la qualité présenteront une affiche et expliqueront le modèle de gestion de l’expérience client ainsi que les résultats obtenus à ce jour.

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Medication reconciliation in homecare: Sharing our process and strategies
Pamela Stuckless, Best Practices Spotlight Organization (BPSO) and Manager, VHA Home HealthCare

To foster quality improvement and patient safety at VHA Home HealthCare the Best Practices, Research and Education team explored strategies to engage leadership and point of care staff in an effort to improve the medication reconciliation (MedRec) process. Chart audits indicated that MedRec was initiated on admission approximately 80% of the time; however the quality of the reconciliation process was unacceptably low. The team met with stakeholders including, nursing supervisors and point of care nursing staff, completed an internal and external environmental scan, and consulted the ISMPs Getting Started Kit for MedRec. Data collected from this process led to the revision of the MedRec policy and procedure and adaptation of resources outlined in the Getting Started Kit. The new process was launched to a nursing team in the Central East LHIN. Areas for clarification were identified and positive feedback was received. The MedRec process is now covered more in-depth at nursing orientation, including the use of case studies and opportunities for hands on application. In early 2014, an interactive MedRec e-learning module will be rolled out to current nursing staff and future new hires. VHA will continue chart audits of the established process and make revisions as necessary.

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Opportunities and tensions to improve quality in Ontario
Dr. Joshua Tepper, President and CEO, Health Quality Ontario

There are challenges to providing quality care at different levels, from clinics to hospitals, across provinces and beyond. Poor outcomes can result from a complex range of factors that can exist in a single institution around a single patient.

Five critical opportunities will drive quality improvement in our current system: electronic health records; data; the social determinants of health; ensuring collaboration; and building a culture that puts quality first. Currently, it is difficult to obtain data from electronic health records as systems are not connected. For data to be useful, it should be timely, accurate, and disaggregated. What’s more, we should expand the quality framework to include social determinants of health such as housing, clothing, and food. Quality is a team game that requires close collaboration and a pan-Canadian approach.

There are also tensions that we must acknowledge as we move forward with our quality agenda. For example, we need an appropriate balance between quality improvement (low blame, low risk, high engagement) and accountability; rapid-cycle evaluations (trial and tweaking) and peer-reviewed research; reducing variation and the need for local autonomy; and innovation and the scale and spread of proven models.

Finally, to move forward with improving quality, we need to accept the failures in our current system. We need to find a way to have safe, meaningful, and transparent discussions about what we have not done well. Acknowledging failure is part of the path to succeeding.

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Optimisation des processus au bloc opératoire
Stéphane Charbonneau, Directeur de la qualité et de la planification stratégique, CSSS du Sud-Ouest-Verdun

Le CSSS du Sud-Ouest-Verdun, un des trois établissements choisis en 2011 par le MSSS pour implanter l’approche Lean Healthcare Six Sigma, a intégré les principes Lean à sa philosophie de gestion dans le but, notamment, de promouvoir une culture d’amélioration continue de la qualité. Concrètement, une douzaine de projets ont déjà été menés dans le cadre de cette démarche. En plaçant l’usager au cœur de nos préoccupations et en impliquant toutes les parties-prenantes, médecins et employés en premier lieu, cette approche a donné des améliorations réelles. Le projet d’optimisation des processus au bloc opératoire illustre notre démarche. Le projet visait l'optimisation de l'utilisation des salles d'opération du bloc opératoire et, d'autre part, l'utilisation judicieuse des ressources de ce même secteur. Les objectifs fixés  ont été atteints par rapport à l’augmentation de la capacité moyenne des activités (cible +5%, résultat +8%) et à l’augmentation du taux d’utilisation des salles d’opérations (cible +10%, résultat +10%). Plusieurs changements ont été faits pour atteindre ces cibles, par exemple, l’aménagement d’une salle d’induction, la standardisation des équipements et l’utilisation d’une liste de vérification préopératoire.

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Patient-centered care
Judy Shearer, Program Director, Inner City Health Program, St. Michael’s Hospital
Andre Palmer, Program Director, Specialized Mental Health Program, Grand River Hospital

Background: In 2010 the Grand River Hospital, Mental Health & Addictions Program developed a program vision, mission and values that focused on recovery principles. This patient-centred care philosophy was used as a key approach to supporting individual recovery, shared decision making and an improved patient experience.

Methods: Since that time several aspects of care have been realigned to ensure they support this patient-centred care philosophy including implementation of shared care plans; incorporation of a new peer navigator role; and a focus on awareness raising and stigma reduction activities.

These strategies have enhanced patient empowerment, encouraged a strength-based focus, and promoted respect and hope.  Involvement of those with “lived experience” and consideration of patients as partners in care has transformed the patient experience.

Findings: Findings from our patient satisfaction surveys and focus groups, peer navigator evaluation and an internal chart audit will be shared to demonstrate the strengths and limitations of these strategies. Additionally, key learnings and future directions will be shared.

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Pharmacy discharge facilitator for high-risk patients
Colleen Cameron, Clinical Pharmacist, Lead for Pharmacy Discharge Facilitator Project (PDiF), Grand River Hospital

Discharging complex patients safely from hospital is complicated, especially with regard to medications.  If not done well, medication misadventures bring patients back to hospital. PDiF is a QI project utilizing a PDiF team (Pharmacist/Pharmacy student) to transition high-risk patients home safely after discharge from the Medicine program.  

From January - September 2013, the PDiF team was involved:

  1. on admission - identifying high-risk patients
  2. during hospital stay - modifying medications early in their stay to safe / practical choices for discharge
  3. at time of discharge – communicating the medication discharge plan including rationale, with all necessary parties (MDs, RPhs)
  4. post-discharge – phoning the patient to see if they were able to implement their medication discharge plan

Assessed outcomes were qualitative (patient / physician satisfaction) and quantitative (7, 30, 90 day ED visits / readmissions).  The project was successful in all outcomes as well as in other unexpected areas (conservable bed days, collaboration and identification of geographical trends).

Sustainability supported by GRH requires human resource optimization plus fully utilizing current information technology. 

Lessons learned: 1) discharge Med. Rec. starts the day of admission 2) medications delay discharge 3) the magnitude of medication misadventures is still unknown.

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Rapid access to consultative expertise – RACE: An innovative model of shared care
Margot Wilson, Director, Chronic Disease Management Strategy, Providence Health Care
Dr. Garey Mazowita, Head, Department of Family & Community Medicine, Providence Health Care
Clay Barber, Executive Lead, Shared Care Committee, BC Ministry of Health, BC Medical Association

Patients with chronic conditions often navigate multiple care interfaces and may experience fragmented care.  Ideally the locus of care should remain with family physicians (FPs), with specialists supporting the role of primary care.  

In 2010, Providence Health Care partnered with the Shared Care Committee, (a joint committee of the BC Ministry of Health and the BC Medical Association), and Vancouver Coastal Health to facilitate collaboration between specialists and FPs in working together to improve care for patients with complex chronic conditions. Through this work, Rapid Access to Consultative Expertise - RACE an innovative model of shared care was developed where FPs can call one number, choose from a selection of specialty services and be routed directly to the specialist’s cell phone for “just-in-time” advice.

Interviews, focus groups and surveys involving FPs, specialists and patients were completed to measure use, benefits, areas for improvement, and ability to increase knowledge. 90% of the calls were returned within one hour (80% returned within 10 minutes) and 90% of calls were <15 minutes in length.  60% of calls avoid a face-to-face consult with a specialist and 32% avoid an emergency department visit. User satisfaction was unanimous; all FPs indicated they would use the service.

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Sécurité des services et gouvernance
Manon Campeau, Conseillère à la sécurité des soins et services aux usagers et à la gestion des risques, CSSS Pierre-Boucher
Joanne Blondeau, Conseillière en assurance qualité, CSSS Pierre-Boucher

La gestion des risques a beaucoup évolué au cours des dernières années dans le réseau de la santé et des services sociaux. Le concept englobe les preoccupations reliées à la presentation de soins et services sécuritaire auxquelles s’ajoutent les preoccupations liées à la gouvernance.

En ce sens, le CSSS Pierre-Boucher s’est dote d’un cadre de reference de gestion intégrée des risques qui encadre le processus d’analyse et de traitement des risques cliniques et administratifs de l’organisation dans une perspective d’amélioration continue de la qualité.

Le modèle de gestion intégrée des risques administratifs du CSSS est inspire du modèle global des risques des entités du Committee of Sponsoring Organizations of the Treadway Commission (COSO).

Le processus est constitué de huit composantes :

  1. Établissement du context
  2. Détermination des objectifs
  3. Identification des risques
  4. Évaluation des risques
  5. Traitement des risques
  6. Activités de contrôle
  7. Information et communication
  8. Évaluation et amelioration

Le modèle de gestions des risques administratifs a été appliqué pour identifier les risques spécifiques de la direction des services financiers au cours de l’année2012-2013. L’exercice d’analyse des risques administratifs est en cours avec la direction des services techniques (exemple de categories de risques identifies : gestion sécuritaire du bâtiment, gestion de projets de construction, gestion des équipements, service g’hygiène et salubrité, service alimentaire, etc) et de la direction des communications et des relations publiques.

Suite à l’analyse, les directions élaborent un plan d’action en collaboration avec les membres de leur équipe et les parties prenantes des autres services dans une perspective de maîtrise des risques et d’amélioration continue de la gouvernance du CSSS.

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Sustainable standardized surveillance for healthcare associated infections in Alberta
Kathryn Bush, Senior Surveillance Consultant, Infection Prevention and Control, Alberta Health Services
Jenine Leal, Senior Surveillance Consultant, Infection Prevention and Control, Alberta Health Services

The creation of a provincial Infection Prevention and Control (IPC) program resulted in a comprehensive system for surveillance of health care associated infections in Alberta Health Services (AHS) and Covenant Health (CH), providing critical capacity for real-time analysis of IPC surveillance data across all Alberta hospitals. Accountable to the Provincial IPC Committee, the Surveillance Committee approved a program using protocols created by a working group of Infection Control Professionals (ICPs), IPC physicians and epidemiologists. The IPC Surveillance team is responsible for generation of quarterly surveillance reports to the organization. ICPs provide data through a secure web-based data entry system and have the capacity to retrieve surveillance data to generate reports that support patient safety interventions, program planning and evaluation. IPC communication through the surveillance system tracks patients' transfers throughout the province for prompt isolation and safe patient management practices related to Antimicrobial Resistant Organisms and C.difficile infection. The IPC Surveillance team provides expertise in protocol development, data quality and education to all ICPs participating in acute care surveillance. Provincial participation at all acute care sites enables accurate representation of outcome and/or process measures. Common surveillance goals create an environment for effective communication, improving patient safety for all acute care sites.

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Sustaining a pressure ulcer prevention program in Complex Continuing Care (CCC)
Jolene Heil, Advanced Practice Nurse, Clinical Nurse Specialist, Wound Care, Providence Care

It was recognized through quality improvement data that our CCC population had a pressure ulcer prevalence rate that was higher than average rates of similar care populations across the province.

Methods: An Interprofessional Wound Care Resource Team (IWCRT) was developed and members attended wound care training in June 2011. A Pressure Ulcer Prevention Program was purchased to assist with strategies for implementation. 7.5 hours of nursing time is dedicated each week for wound management. Team members document wound measurements on flow sheets and take digital photos for tracking the progress of wounds. The team meets weekly to update care plans and discuss treatment strategies for patients. 

Results: The data has shown a decline in new and worsening pressure ulcers resulting in a risk-adjusted rate that has been in line with the provincial average for 8 of the past 10 quarters. Proper use of advanced wound care products and improvement in severity of wounds has resulted in a product cost savings of 25%.

Conclusion: In order to make a significant impact on prevention and treatment of pressure ulcers, resources for staffing, education, and equipment must be planned and budgeted for on an ongoing basis.

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Sustaining quality and clinical excellence: How the space program has lessons for health care
Dr. Dave Williams, CEO, Southlake Regional Health Centre

Space is an operational environment similar to health care; time-critical decisions have life or death outcomes that cannot be reversed. The space program is an example of a high-reliability institution whose ingrained attributes — vigilance, root cause analysis, awareness, and trust — are equally applicable in the health care sector.

The key to excellence in the space program is the link between culture and sustainability. In health care, a culture that puts patients first while also taking care of staff members, will result in positive outcomes. Health care must fight normalized deviance — accepting something we do not think is appropriate — by embracing positive deviance, or the process of aligning culture with patient safety and quality outcomes.

This requires building emotional intelligence across an organization, supporting inter-professional practice that encourages leadership and followership. The “failure is not an option” culture encouraged non-critical, introspective thinking and clear communication so the damaged Apollo 13 spacecraft could be brought home. This same approach in health care will require courageous conversations, but having them will result in sustained excellence.

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The Big Q: What does “quality” mean to a patient?
André Picard, Journalist, The Globe and Mail

The long answer to that question is a book entitled Path to Health Reform, which is available for free by contacting Mr. Picard. The short version is that patients want prompt, safe, efficient, accessible, and affordable care.

How are we doing right now? We are not prompt. Are we safe? One in 10 hospital patients suffers an adverse event. Efficient? Overall, we are pretty efficient. Accessible? More or less, depending on where you live. Affordable? Not to everyone.

We need a culture of safety, not a culture of volume as we now have. We need patient-centred care, hospitals that are more welcoming, and transition points that are easier to navigate. The environment matters, so we need to decrease noise. We need to improve service providers’ attitudes; they often appear overworked, busy, and grumpy. And finally, we should invest in electronic records.

Quality should be an essential goal for all health systems.

What role can Accreditation Canada play in improving quality care? Accreditation Canada has been contributing to changing the culture of quality in our health systems. It could have a role in improving quality in health care by getting the public engaged, publishing summaries in plain English, and doing more on the customer service side of health care delivery.

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The Denouement: Untangling the relationship between suicide, data analytics, social media, and proactive mental health care
Shelley McKay, Patient Advocate and Strategic Risk Management Consultant

Shelley McKay, a patient advocate and strategic consultant, shared her experience of trying to navigate the health care system following her teenage daughter’s attempted suicide. Shelley described her struggles with front-line staff, the lack of knowledge around youth mental health issues, and non-existent follow up. She was moved to act and met with hospital executives to discuss her experience and the processes that could be put in place to better serve youth with mental health issues and their families.

When she was advised that her daughter was having suicidal ideation and posting this on social media sites, she used her professional knowledge to develop a tool that uses social media, analytics, predictive models, and keywords and phrases associated with known risk factors to identify youth with suicidal behaviour/ideation at the earliest possible point.

The goal of her project is to reduce the pressure on our region’s emergency rooms by proactively identifying youth in crisis and directing them to appropriate treatment. By analyzing mood, identifying mood trends, and assessing mental health risk, it is possible for parents, schools, and hospitals to take a proactive care approach rather than a reactive one.

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Time for change: Engage and empower patients and families
Barb Farlow, Patients for Patient Safety Canada

Barb Farlow’s daughter was born with a genetic condition that required a significant amount of health care intervention. Both Barb and her husband believed the health care team that cared for their infant daughter, who died following a surgery, provided the best possible care. Yet, when they began to investigate their daughter’s death more closely, they discovered that she died as a result of treatment policy decisions, none of which were communicated to them despite their constant presence.

The shock of their daughter’s death was compounded by the fact that their situation was not, in fact unique; systemic errors and a lack of transparency around organizational policies occur more frequently than they expected.

There is a need to strike a balance between busy care providers (or providers who do not want to scare patients) and patients who may be scared and require answers but do not want to be perceived as annoying by their care providers. This balance can be realized by ensuring that patient-centred care is built into the system. Patients and families aren’t going anywhere, so engaging and empowering them will result in improved quality and safety.

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Use of CUSP methodology to reduce surgical site infections at the Ottawa Hospital
Dr. Husein Moloo, Interim Chief, Division of General Surgery and Director, Minimally Invasive Surgery, The Ottawa Hospital; Assistant Professor and Interim Chair, Division of General Surgery, University of Ottawa
Rebecca Brooke, Quality Improvement Coordinator, The Ottawa Hospital

The Comprehensive Unit-based Safety Program (CUSP) was developed by Johns Hopkins and reduced surgical site infections (SSIs) in colorectal surgery. CUSP at The Ottawa Hospital (TOH) began in March 2013. The aim is to reduce SSIs from the 2012/13 average of 4.6% to 4.0% by March 31, 2014, and improve the overall quality of surgical care, as measured by the National Surgical Quality Improvement Program (NSQIP). The principle of CUSP is that frontline multidisciplinary teams drive change in partnership with senior executives.

To date, 13 CUSP teams were formed based on surgical specialty, location, or primary issue. Frontline providers were surveyed for improvement ideas via a two question survey: “How do you think the next patient will be harmed?” and “What can be done to prevent that harm?” Process improvements were achieved in antibiotic timing and re-dosing, wound management, and peri-operative warming among other topics. Teams also address unit-specific issues such as patient experience and falls through process changes and education.

Achievements include high frontline engagement; communication across disciplines, work areas, and levels of management; increased visibility of NSQIP data; and importantly improved patient satisfaction scores. Sustainability is likely due to involvement of all stakeholders, changing unit-level culture, and addressing root causes. Tracking of SSI rates will continue through NSQIP.

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Using a Quality Improvement Approach to Improve the Patient Experience in Partnership with Patients
Debbie Marshall, Clinical Manager, Radiation Oncology and Hematology, The Ottawa Hospital

Patient experience is what the process of receiving care feels like for the patient, their family and caregivers. The Ottawa Hospital (TOH) measures patient experience using the NRC Picker survey, with the aim of receiving an "excellent" rating of care provided from 51% of discharged patients. At present, there is wide variability in the percent "excellent" scores across inpatient units. A quality improvement approach is being used on two units with room to improve.

This approach is novel to TOH as it emphasizes engaging patients and their families at the same time as frontline staff, to identify and correct local unit issues that impact on quality of care provided. Patient representatives have been recruited to participate in all phases of the quality improvement journey. Current inpatients are interviewed by patient volunteers to assess the current state, and former patients and caregivers are members of the action teams leading change.

Where processes and resources for patient involvement exist, they have been helpful, but there are many areas where the project must break ground and establish new processes for involving patients. Another challenge has been balancing staff needs, patient desires, and corporate objectives. Major successes to date can be attributed in large part to adapting the approach to fit the unit culture.

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Web-based learning to improve patient-centered care
Dr. Tannys Vause, Assistant Professor, Department of Obstetrics & Gynecology, Division of Reproductive Medicine, University of Ottawa

Physicians must provide patients with helpful, timely and easily accessible information to guide them through medical processes. In response to this need, the Ottawa Fertility Centre (OFC) offers internet-based learning. The OFC has developed an online education program for patients starting their first cycle of Superovulation/Intrauterine Insemination, which they complete before starting treatment. Upon completion, patients submit a knowledge and satisfaction survey to ensure they understand the treatment they will undergo. 

This solution has several advantages, including improved patient-centered care through increased information accessibility and flexibility of use, while also delivering financial efficiencies to clinics. Patients can access the information on their terms and schedules, following along at their own individual pace of learning.

This project was created after a previous successful randomized controlled trial developed to deliver and assess web-based learning material to In Vitro Fertilization (IVF) patients. This showed that patients were significantly more satisfied in the web-based group, with comparable retention of information.

Ultimately, delivering web-based learning to our patients makes their lives easier, as it gives them control over how they access and progress through educational material. This empowers patients and delivers a more personalized and satisfying experience during a stressful time in their life.

The presentation outlines the work of the committee including its composition, its processes and tools and the results of a formal evaluation of its work.

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Recognizing the 2013 winners!



 Proud winners of the 2013 Leading Practices awards!

Each year the Quality Conference includes a ceremony to present Leading Practices awards to organizations with highly effective initiatives. This popular event inspires everyone to pursue quality improvement and engage in knowledge transfer.

109 Leading Practices submissions were accepted for the Accreditation Canada Leading Practices Database.  Representatives from organizations were present to receive their award certificate from Paula McColgan,  Vice-President, Business and Engagement at Accreditation Canada.

Learn how your organization can submit Leading Practices via the Accreditation Canada website.

The Leading Practices Database now serves as the new location for innovative practices from the former Health Council of Canada Health Innovation Portal.