Quality Improvement Plans: Meaningful change and more value
As we begin a new year and look towards further enhancing quality care in Ontario, it’s a good time to reflect on the annual public commitment that health care organizations make to their communities through their Quality Improvement Plans (QIPs). These plans share what was achieved to improve care in the previous year and set out how they will improve health care quality within their organizations in the coming year.
On April 1, 2019, more than 1000 QIPs will be submitted to Health Quality Ontario by hospitals, long-term care homes, home-care organizations and primary care teams and simultaneously shared with their local communities.
It is worth remembering that QIPs have only been required in Ontario for the past eight years, starting with Ontario’s 142 public hospitals. The original QIP stated “they should be seen as a tool, providing a structured format and common language that focuses an organization on change.” This was a major shift from the prevailing, more ad hoc approach to quality most Canadian health care organizations took, where there was limited support for local improvement efforts and as a result, change was diffused.
Quality Improvement Plans are more than just pieces of paper or words on a computer screen. They are a public declaration to improve care and a commitment to follow through on the changes that organizations say they will make. These plans are not a snapshot, but rather a one-year or even a multi-year commitment to change. The most progressive organizations have engaged front-line providers and patients to determine what changes would be most meaningful to them, to make care better.
QIPs represent the largest mandated bed-side to boardroom quality initiative in the world. Without being too prescriptive but setting a minimum set of priorities to focus on, quality improvement plans helped jump start a recognition of the importance of quality in the everyday work of everybody in the health care system – turning it into a routine, public annual process. In many ways, this commitment to change and achieving measurable results have become part of the DNA of the Ontario health care system.
Dr. Ross Baker, professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto and a leading expert on quality care, has noted that QIPs have created a strategic focus to improving performance in the province’s health care system.
For example, the recent Auditor General of Ontario report on Health Quality Ontario noted that the focus on hospital-based infections in the QIPs has contributed to a significant (31%) reduction in the rate of such infections due to clostridium difficile from 0.35 per 1,000 patient days in 2011/12 to 0.24 per 1,000 patient days in 2016/17.
Last year, Health Quality Ontario approached the people who prepare and participate in quality improvement plans and asked them if they believed the plans and the process were bringing value. The answer was positive. About 70% of those surveyed felt that QIPs had brought focus to quality issues, motivated organizations to talk about quality improvement and put their words into action. People also said that developing QIPs is promoting a quality driven culture.
One need only look to Quorum, Health Quality Ontario’s online forum, to see dynamic examples of how various organizations and groups of health care organizations have made a commitment to change and have acted on their plans.
But this evaluation also identified areas where people felt the QIPs could be made more useful and we have responded to that feedback.
As a result, the latest iteration of QIPs is simpler, brings a focus to a smaller number of priorities and increases the ability of the plans to impact meaningful improvements in care. Most importantly, the change aligns QIPs with system priorities such as addressing hallway health care, mental health care, and service excellence. All of these were identified as areas needing attention in this year’s Measuring Up report that assesses how Ontario’s health care system is performing.
The community of those committed to quality is a special one with Quality Improvement Plans helping give that passion a focus. We are confident the new direction will continue to harness that passion, more strongly align the program to system priorities, and address the issues that matter most to Ontarians and their local communities.
Go here to learn more about the priorities for the 2019-20 Quality Improvement Plans, and to access guidance materials and the technical specifications.