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Dr. Joshua Tepper and Dr. Irfan Dhalla

Quality Care: From Good to Great

Everybody wants quality health care. Why wouldn’t they?

This belief, which underpins the work of Health Quality Ontario, was recently endorsed by no less than the World Health Organization, World Bank and Organization for Economic Co-operation and Development Countries in a major report on global health care. They stated “even with essential health coverage and financial protection, health outcomes would still be poor if services were low-quality and unsafe”.

In a recent commentary in the CMAJ, we summarized data demonstrating that the quality of health care in Canada is good but not great. We also made several suggestions for improvement. In the article, we focused not on the things that individual clinicians could do differently, but rather on decisions that managers, administrators and policy makers can make. While most quality improvement initiatives are necessarily local, we feel certain key steps could be taken across the whole country.

Among the system-level steps we proposed to improve health care quality are:

• Publicly fund treatments that are proven to be cost-effective, and discontinue funding for those proven to have little or no benefit.
• Invest in primary care.
• Involve patients in deciding what services to provide, and how to provide them.
• Ensure electronic medical records’ systems can work seamlessly together and also provide patients with access to those electronic records.
• Involve physicians in decision-making and ensure the well-being of health professionals.

Each of these suggestions should be a major area of focus. For example, in response to our commentary, the well-respected CBC host of White Coat, Black Art and emergency physician, Dr. Brian Goldman focused positively on our proposal to involve patients more in decisions about care. “There are many people who work in health care who are apt to ignore the suggestions of patients. That, in my opinion, is a mistake,” he wrote, also adding that he agreed with the article that it would be a mistake not to involve physicians.

Too often, conversations about quality care can deteriorate into meaningless platitudes or become esoteric conversations about how and what to measure.

We think a more productive conversation could be prompted nationwide by hearing your ideas for what organizations like Health Quality Ontario can do to make it easier for clinicians to provide high-quality care. We invite you to join us on Oct. 23 at 8 pm (ET) on Twitter to discuss them using the #HQOchat hashtag:

• Q1: What more can managers, administrators and policy makers do to help improve health care quality?
• Q2: What barriers need to be removed so that front-line clinicians can more easily provide high-quality care?
• Q3: How can we better involve patients at the system level, so that the way we provide health care best reflects the priorities and needs of patients?
• Q4: What should be done to ensure the physical and emotional wellbeing of physicians, nurses and other health care professionals?
• Q5: In a conversation on quality health care, how much emphasis should we put on social determinants of health such as decent housing and proper education?
• Q6: Recognizing that Canada has many different provincial/territorial health care systems, what can we work on together nationally (at a pan-Canadian level)?

Looking forward to discussing with you on Twitter on October 23rd at 8 pm (ET): #HQOchat


4 comments on article "Quality Care: From Good to Great"

Margie Kennedy

It would be great to host a WebEx or other virtual meeting in addition to twitter to have this important conversation.

Wanita Umer

A Standard should not be a do or don't in most cases. eg-Don't prescribe a benzodiazapine with an opioid. Such a blunt recommendation leaves no room for situations when it may very well be appropriate to prescribe the two medications, especially when one is not taken at the same time as another. A Standard such as 'Carefully assess all risk factors before prescribing a benzodiazapine to a patient who is prescribed an opioid'. would leave room for patients who may need both.HQO 's blunt Standards is ensuring that one size fits all care is being applied to patients.

annick aubert

mental health is health , I agree but mental health can only be achieved if a person knows he or she is lacking in mental health. Severe mental illness often going unnoticed ( anosognosia) does not fit the general pattern. I cannot attend the webinar

Patricia Forsdyke

Sadly serious mental illness is still the orphan of health care. There is a lot of talk about the wellness stuff and happiness index, but this wooly stuff does not really do much. People who present with schizophrenia and allied conditions should be a top priority in terms of receiving professional medical help and adjunct social help . These are profound medical conditions that are still not appreciated as such and persons with them often end up in prison or on the street as the homeless. These conditions afflict the rich and the poor.. When are policy makers going to recognize these awful illnesses as such.

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