In 2010, the Excellent Care for All Act (ECFAA) became law in Ontario. One of changes that ECFAA brought was the establishment of Health Quality Ontario (HQO) www.hqontario.ca, a Crown agency accountable to the provincial government.
HQO has a broad mandate to monitor, report on, and lead improvement in the quality of health care in Ontario. Specifically, HQO is accountable to
- Monitor and report on how the health system is performing
- Provide guidance on important quality issues
- Assess evidence to determine what constitutes optimal care
- Engage with patients and give them a voice in shaping a quality health system
- Promote continuous quality improvement aimed at substantial and sustainable positive change in health care
Each year, HQO publishes a report on the performance of Ontario’s health system and the health of Ontarians. The report, called Measuring Up, tracks progress of a set of quality indicators across six domains of quality - safe, effective, patient-centred, efficient, timely, and equitable.
In last year’s report, several issues were identified for improvement. Patient transitions from one part of the health system to another continue to need improvement, particularly for people experiencing mental health or substance use concerns and for those receiving palliative care. Access to care continues to be an issue for many Ontarians, with only 43.6% of adults able to get appointments with their primary care provider the same day or next day. There is also significant variation across the province. If you live in northwestern Ontario, you are much less likely (23.8%) to be able to see your primary care provider within 48 hours of identifying a need. Variation across the province can be seen in other areas too. For example the percentage of long-term care home residents that were physically restrained ranged from a low of 2.3% to a high of 13.3%.
Multiple strategies are being used to achieve needed improvement. The Ministry of Health and Long-term Care’s Patients First: Action Plan for Health Care outlines changes that are designed to improve access to care, particularly in home and community and primary care. HQO is leading and supporting many initiatives including the development and recent release of three new standards to guide quality practice in Ontario. The new Quality Standards (http://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards ) have clinical guides for health practitioners and reference guides for patients and families. Developed with input from both health providers and recipients of care, they are evidence-based sets of easy-to-understand statements that are intended to
- Help patients, residents, families, and caregivers know what to ask for in their care (patient reference guides)
- Help health care professionals know what care to offer, based on evidence and expert consensus (clinical guides)
- Help health care organizations measure, assess, and improve the quality of care they provide
- Help ensure consistent, high quality care across the province so that all Ontarians receive the best possible care.
These first three Quality Standards address some of the areas for improvement identified in the 2016 Measuring Up report and will be useful to many nurses working in a variety of settings. They are:
- Behavioural Symptoms of Dementia: Care for Patients in Hospitals and Residents in Long-Term Care Homes
- Major Depression: Care for Adults and Adolescents
- Schizophrenia: Care for Adults in Hospitals
Ontario’s RPNs can participate in the Quality Standards program in a number of ways. First of all by being familiar with the standards that apply to your areas of practice and helping to implement these in your health care organization, you can play an important role in improving the standard of care for patients and families and reducing variation across settings. You can also suggest other topics to HQO for the development of new Quality Standards. 98% of Ontario’s RPNs provide direct care to patients and families. They have vital knowledge and expertise to contribute to quality care. RPNs can apply to be a member of a Quality Standard Advisory Committee to help with the actual development of new standards. At the time of publication of this article, HQO had posted a call for applications for advisory committee members for standards related to Chronic Obstructive Pulmonary Disease as well as Osteoarthritis. Secondly, when a new draft Quality Standard is developed, HQO posts the draft for feedback. RPNs can review draft standards and provide constructive feedback to HQO about the draft.
Striving for quality practice…we’re better together!
Director, Nursing Innovation