Tag: quality

Improving appropriateness of antipsychotic use in long-term care

Antipsychotic use in LTC

When prescribed appropriately – to treat psychosis related to a psychiatric condition like schizophrenia – antipsychotic medications can improve a patient’s quality of life. However, too often it appears antipsychotics are being prescribed to residents of Long-Term Care Homes (LTCH) to control behavioral symptoms of dementia (such as verbal or physical aggression) without a concurrent…

Safe surgery checklists: the Canadian experience

Safe surgery checklist

Each year there are patients who wake up from surgery to find an operation has been done on the wrong part of their body. These wrong-site surgeries are an example of “never events” – incidents that simply should not happen if all safety measures are taken. Nevertheless, these events take place each year in countries with…

Should hospital staff satisfaction survey results be public?

Patients and their families were treated with “callous indifference.” Water was left out of reach. Soiled bed sheets weren’t changed, sometimes, for months. The abuses that took place between 2005 and 2008 in an England hospital shocked the country. A 139-day public inquiry revealed that there were many signs leading up to the abuse. If acted…

Decision aids: why hasn’t this proven, patient-centred practice caught on?

Decision aids

Health care has supposedly entered an era of patient involvement, where important medical decisions are shared between doctors and patients. But many believe that the reality in Canadian health care falls well short of this ideal. Complex medical decisions can prove difficult for patients, who are often faced with dizzying amounts of information about benefits and risks,…

Pulling back the curtain on Canada’s rising C-section rate

Caesarian sections (C-sections) are among the most common surgical procedures performed on women of child-bearing age. Canada’s C-section rate has increased dramatically in the past two decades. The national C-section rate  has increased from 17% of all births in 1995 to nearly 27% in  2010. In Ontario, nearly 29% of births in 2011/12 were by C-section, with a similar rate in Alberta of…

Can quality be assured for diagnostic imaging?

radiology

News headlines from across Canada are periodically dominated by scandals and errors in diagnostic imaging. The list grows each year, with errors exposed from coast to coast. The narrative follows the same arc – an error is discovered in an area of diagnostic imaging. A radiologist – generally the physician involved in the interpretation of…

Improving quality in Canada’s nursing homes requires “more staff, more training”

Improving quality in Canada’s nursing homes requires “more staff, more training”

Over 100,000 patients are cared for in Alberta and Ontario’s nursing homes every year. Many residents and families are quite happy with the care provided in nursing homes. However, news reports from home and abroad remind us that not all nursing home residents receive the same quality of care. Ontario has launched several quality initiatives for long term…

Can “bottom up” measurement improve the quality of Canadian health care?

Can “bottom up” measurement improve the quality of Canadian health care?

Progress has been made in measuring the quality of Canadian health care. Yet there are still large gaps in what is measured in our health care system, and much of what is measured is only useful to top-level system managers, not to the front-line clinicians whose day-to-day work is so important to the overall quality of the system. This leads experts to question whether measurement is being used effectively to improve the quality of Canadian health care.

Increasing access to surgery without considering appropriateness leaves patients in the dark

Increasing access to surgery without considering appropriateness leaves patients in the dark

Over the last decade, most Canadian provinces have shortened wait times for many surgical procedures, including hip and knee replacement. However, while provinces have poured resources into improving access, they have paid relatively little attention to measuring outcomes of these surgeries. The result, experts believe, is that some patients may be undergoing surgery when it is not…

Health Links: Ontario’s bid to provide more efficient and effective care for its sickest citizens

Health Links: Ontario's bid to provide more efficient and effective care for its sickest citizens

Ontario’s Health Links initiative is a “big manoeuvre” in a complex provincial system, acknowledges Helen Angus, associate deputy minister with the transformation secretariat of the Ministry of Health and Long Term Care (MOHLTC). The initiative aims to facilitate coordination of care at a local level for high needs patients. It comes in the wake of…

Should cautions issued to health professionals be publicly reported?

Should Ontario's Regulatory Colleges Publicly Report Cautions?

Last week, the governing council of the College of Physicians and Surgeons of Ontario (CPSO) voted unanimously in favor of changing its bylaws to allow for public reporting of the results of inspections of Out-of-Hospital Premises, such as private colonoscopy and plastic surgery clinics. This change was made following reporting by the Toronto Star, which…

Hospital crowding: despite strains, Ontario hospitals aren’t lobbying for more beds

Are Canadian Hospitals Overcrowded?

Patients languishing on stretchers in hospital hallways, hospitals issuing capacity alerts when they can’t take more patients, tension in emergency departments as patients wait hours and even days to be admitted. That’s too often the reality in our hospitals. And, given the statistics, you’d think that hospital executives—especially in Ontario—would be pushing hard for more…

Changes called for as 1% of population accounts for 1/3 of health care spending

Changes called for as 1% of population accounts for 1/3 of health care spending

Ontario’s Health and Long-term Care Minister is calling for a change in how health care costs are scrutinized in light of research showing that a tiny proportion of the Ontario population accounts for a very large proportion of health care expenditures. “We need to shift our focus” away from line-by-line scrutiny of hospital, drug and…

Improving quality and access in Ontario’s privately owned colonoscopy clinics

Improving quality and access in Ontario’s privately owned colonoscopy clinics

Five years ago, researchers in Ontario raised concerns about access and quality in privately owned clinics that performed colonoscopy, suggesting that the quality in these clinics was significantly below the standard of care in public hospitals. Privately owned clinics can be either for-profit or not-for-profit. Medical services provided at these private clinics are paid for…

The next challenges for primary care in Ontario

The next challenges for primary care in Ontario

Over the last year, reports have suggested some of Ontario’s new primary care models, which are significantly more expensive than older practice models, have had limited success in improving access and quality. In response, the Ministry of Health and Long Term Care is conducting a review of these models, and had recently instituted a temporary…

Patient-oriented research in Canada: what progress has been made?

PCORI, SPOR, Patient oriented research

The governments of Canada and the United States have patient-oriented research initiatives underway, which share the goals of supporting research that will improve health care systems and directly benefit patients.  However, the mandate, structure and funding of these initiatives differ significantly, with the United States accomplishing a great deal in a relatively short period of…

Money matters: does ‘pay-for-performance’ improve quality?

Ontario physician payment "Ontario Medical Association" OMA Ministry of Health Negotiations health policy health care

In Ontario, new ways of paying doctors have been introduced in an attempt to improve the quality of their services.  One approach is pay-for-performance, which pays doctors for meeting certain treatment goals. However, there is little high quality evidence that pay-for-performance improves the quality of care, and it appears to have had limited impact in…

Does more care mean better care?

Canada United States Health Care Reform Health Care Policy

A recent study found that Ontario hospitals that used more resources and spent more money had better outcomes for acutely ill patients than hospitals that used fewer resources.  These findings go against a previous study that looked at the same question in the United States and found that more resources didn’t impact outcomes.  A better…

Alberta driving quality improvement through clinical leadership

Strategic Clinical Networks

Alberta is introducing Strategic Clinical Networks in areas such as mental health and addictions, cancer care, diabetes, obesity and nutrition. These networks are meant to lead clinical practices province-wide, and improve the quality of care, outcomes and costs of health care services. This is an ambitious undertaking which may contain some lessons for Ontario. Alberta’s…

Should health care workers be required to get the flu vaccine?

flu vaccine

Each year several thousand Canadians die from influenza. Vaccinating health care workers against flu reduces transmission and would protect patients who are most vulnerable.  However, only about 40% of hospital staff in Ontario were vaccinated last winter. Is it time for Ontario to make the flu vaccine mandatory for health care workers? Explaining the influenza…

Hospital accreditation and quality improvement

Hospital accreditation is a process that assesses a hospital’s performance against a set of standards. This process is done differently across provinces and countries. In Canada, most hospitals go through an accreditation process conducted by Accreditation Canada. The accreditation process could be more transparent and provide more information to the public about the quality of…

Gridlock in Ontario’s hospitals

About one in six beds in Ontario’s hospitals are occupied by patients who no longer need hospital care. These beds are called Alternate Level of Care (ALC) beds. Because ALC beds are not available for sick patients in the emergency department, ALC beds are an important cause of emergency department overcrowding. The term ‘gridlock’, used…

Are hand washing rates posted by Ontario hospitals believable?

Ontario’s hospitals are required to publicly report how often staff wash their hands. There is large variation in hand washing rates between hospitals. This variation more likely reflects how hospitals measure hand washing, rather than the frequency of hand washing itself. Ontario’s hospitals are required to publicly release information about how often staff wash their…