QUALITY MANAGEMENT

Quality Management Partnership (QMP)

The Quality Management Partnership between Cancer Care Ontario (CCO) and the College of Physicians and Surgeons of Ontario (CPSO) was established by the Ministry of Health and Long-Term Care in March 2013 to work closely with physicians and other healthcare providers and organizations to design provincial quality management programs in three selected health services: pathology, mammography and colonoscopy.

CPSO
•Regulates the medical profession and defines standards of practice and behaviour in the public interest
•Assesses some practice environments and also has a peer-led assessment model focusing on provider education and quality improvement
•Works closely with its membership, using clinical expertise to inform its work

CCO
•Uses performance reporting and funding levers to drive a provincial quality agenda
•Manages provincial program implementations and engages health professionals to ensure programs are informed by clinical expertise and evidence-based practice

Colonoscopy
Clinical Lead: Dr. David Morgan

Mammography
Clinical Lead: Dr. Rene Shumak

Pathology
Clinical Lead: Dr. Katherine Chorneyko

Questions & Comments for the Quality Management Partnership:
Email: info@qmpontario.ca

Source: Quality Management Partnership - www.qmpontario.ca

Quality-Based Procedures (QBP)

In January 2012, the government introduced Ontario's Action Plan for Health Care. According to the Ministry of Health and Long Term Care, the funding for the healthcare system in Ontario is slowly being reformed (Health System Funding Reform - HSFR). Over the next 3 years (2015-2017), global funding will be reduced to accommodate funding for Quality-Based Procedures.

Quality–Based Procedures (QBPs) are specific groups of patient services that offer opportunities for health care providers to share best practices that will allow the system to achieve even better quality and system efficiencies. The MOHLTC says this approach will reimburse health care providers for the types and quantities of patients they treat, using evidence-informed rates that are associated with the quality of care delivered.

Ten groups of patient services have been launched as Quality-Based Procedures, and detailed clinical handbooks have been developed to support clinicians as they transition to the new procedures. Below are several QBP Handbooks of concern to General Surgeons:

• Cancer Surgery QBP Clinical Handbook [PDF – posted February 2015]
• Quality-Based Procedures Indicators [PDF – posted April 2014]
• GI Endoscopy QBP Clinical Handbook [PDF – updated April2014]
• GI Endoscopy [PDF – updated September 2013]

For more information, contact the MOHLTC/Health System Funding directly:
Email: HSF@ontario.ca
Phone: 416-327-8379

Source: MOHLTC QBP

National Surgical Quality Improvement Program (NSQIP)

In December 2014, OAGS Board Member Dr. Tim Jackson (Toronto) was successful in helping to establish a partnership with Health Quality Ontario to fund the National Surgical Quality Improvement Program (NSQIP) in Ontario.

NSQIP is a quality improvement system initially organized by the American College of Surgeons, which enables the standardized capture of risk-adjusted data about surgical outcomes and allows comparison between groups. Because of its success in other regions of Canada and the United States, Health Quality Ontario has brought it to Ontario. This program has been initiated by surgeons, not by administrators, and has had remarkable successes in improving patient care and outcomes and decreasing surgical complications as well as the cost of health care delivery.  This is not just for academic surgeons either.  In British Columbia, it was initiated and championed by community surgeons before being expanded to academic centres.

In its first phase, NSQIP-ON has begun in 16 hospital sites. HQO will support these hospitals financially throughout this initial 18-month phase, which will end September 30, 2016. During this time, the respective lead surgeon and CEO hospital teams will: contribute online feedback, collect clinical data on surgical outcomes, benchmark surgical outcomes, provide feedback and suggestions for improvement to surgeons on risk-adjusted outcomes, and establish common improvement goals overall.

• Benefits of NSQIP-ON: Download PDF
  
• Phase I Participating Hospitals: Download List PDF
• More NSQIP Details: www.hqontario.ca
• HQO Surgical Quality Improvement Network: www.hqontario.ca/nsqip-on

Interested in joining NSQIP-ON and the Ontario Surgical Quality Improvement Network?
In an effort to expand NSQIP-ON beyond the funded cohort, HQO encourages all of Ontario’s hospitals to enroll in the American College of Surgeon’s (ACS) NSQIP and join the Ontario Surgical Quality Improvement Network. Participation in the Network will help to support surgical quality improvement initiatives in your organization and is expected to accelerate the achievement of long-term quality improvement goals. It is also an indication of your organization’s interest in participating in future phases of NSQIP-ON. To find out how your organization can get involved, contact NSQIP@hqontario.ca.

Source: HQO-NSQIP-ON www.hqontario.ca

Surgical Safety Checklist (SSCL)

In 2008, the World Health Organization (WHO) launched the Safe Surgery Saves Lives campaign to improve surgical care around the world. In response to this, the Ontario government required Ontario hospitals to adopt Surgical Safety Checklists (SSCL). Similar to a pilot's checklist before take-off, an SSCL is a final check prior to surgery. It is a patient safety communication tool that is used by the surgical team (i.e. surgeons, aneasthetists, nurses) to discuss important details about each surgical case in order to improve the patient's surgical outcome.

Basically, it consists of 3 different phases of surgery: Briefing (prior to induction of aneasthesia there are checks to confirm right equipment, right patient, right side, etc.), Time Out (immediately prior to skin incision, there are checks about antibiotics, patient positioning, etc.), and Debriefing (just prior to the patient leaving the OR, the surgeon/anaesthetist reviews important items and the nurse reviews correct count).

While it's felt that many medicolegal difficulties can be mitigated by using the checklist, some studies since the inception of the SSCL argue that Ontario hospitals see no measurable improvements in their safety records after having implemented the checklists.

Checklist Sample: Download PDF

Sources: OHA-MOHLTC Surgical Safety Checklist Implementation Toolkit, CMPA,

Cancer Guidelines

NOTE: In 2019, Cancer Care Ontario folded into Ontario Health but has retained its website thus far: www.cancercareontario.ca .

SCREENING CONTROVERSIES: OMR Op/Ed "FIT Testing: A reality check for family physicians", Aug,2019 - download

CCO Cancer Guidelines: https://www.cancercareontario.ca/en/guidelines-advice

CCO Screening Guidelines: https://www.cancercareontario.ca/en/get-checked-cancer

ColonCancerCheck - Colorectal Screening Program: https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/colon-cancer-check-colorectal-screening

In 2008, Cancer Care Ontario and the MOHLTC developed what is referred to as Disease Pathway Management (updated). These pathways will encompass a framework for examining and identifying any gaps in the care of the patient through his/her cancer process - from prevention to the end-of-care. It is anticipated that the CCO intends to create a pathway for the most common types of cancer.

Ontario Health: https://www.ontariohealth.ca/

For more details, contact the CCO directly:
Email: disease.pathway.management@cancercare.on.ca

Best Practice in General Surgery (BPIGS)

The BPIGS group was developed in 2006 with the aim of standardizing general surgical procedures across the University of Toronto affiliated hospitals. It has developed 6 clinical practice guidelines (i.e. surgical site infection, mechanical bowel prep, thromboprophlaxis, intra-abdominal infection, enhanced recovery after surgery, periop pain management) and an app to accompany them. For more details, check out their website: www.bpigs.ca .

Wait Time Information System (WTIS)

The Ministry of Health and Long-Term Care contracted Cancer Care Ontario (CCO) to develop and operate the Wait Time Information System (WTIS) for the government's Wait Time Strategy in its entirety. The Wait Time Strategy initiative strives to reduce wait times for and to improve access to a broad range of healthcare services for all Ontarians. In addition to cancer surgery, the CCO also monitors and manages wait time performance for radiation and systemic therapy at both the provincial and regional/local LHINs (local health integration networks). The wait times for cancer surgery are published on the MOHLTC website, while the others are reported on the CCO site. The WTS Clinical Lead for General Surgery is Dr. Ori Rotstein, whom was appointed by Dr. Alan Hudson - Lead of Access to Services and Wait Time Strategy. Practical Guides inclusive of case studies for General Surgery should be available through your hospital's WTIS Coordinator or here.

The MOHLTC's plan to increase access and reduce wait times for major health services in Ontario includes General Surgery and cancer surgery, in particular.
It's 4 main goals are:
•Significantly increase the number of procedures to reduce the backlog that has developed over the last decade.
•Invest in new, more efficient technology such as MRI machines and longer hours of operation.
•Standardize best practices for both medical and administrative functions in order to improve patient flow and efficiency.
•Collect and report accurate and up-to-date data on wait times to allow better decision making and increase accountability.

Surgeon Wait Time Dashboard - COMING SOON!
This brand new province-wide initiative will be launched during the week of July 20, 2015. It is an informational quarterly wait time report that is to be emailed directly to surgeons who report into the WTIS - strictly on a voluntary basis. According to CCO,

"It is a tool to help increase surgeons’ awareness of their individual and comparator wait time data, and to support them in identifying areas of opportunity to drive further improvements in patient access. The dashboard is specific to each surgeon and will only be emailed to the individual surgeon’s hospital email address as well as their hospital WTIS Coordinator for support. The dashboard was developed based on feedback from over 200 surgeons across Ontario during two pilots. By reviewing the dashboard, a surgeon may be eligible to earn Continuing Professional Development credits with the Royal College of Physicians and Surgeons of Canada. The estimated time commitment for a surgeon is 15 minutes to review each quarterly dashboard plus any additional time a surgeon may choose to invest in feedback activities. ATC will be working closely with your hospital WTIS Coordinator over the next few months to collect surgeon hospital email addresses and distribute communications to surgeons. As well, your CIO will be receiving a separate letter with further details and technical requirements." - Access to Care
For more information, contact the WTIS Coordinator at your respective hospital or contact the WTIO.
There are also some webinar sessions...

Session #5	Tues., June 23, 2015	4p.m. to 5p.m.	https://cc.callinfo.com/r/1jns7cg0nvkd4&eom	Number: 416-620-7077 or 1-866-834-7685 Participant code: 8373949#
Session #6	Thurs., June 25, 2015	7a.m. to 8a.m.	https://cc.callinfo.com/r/1atjl1gj4mh7m&eom

Sources: MOHLTC Wait Time Strategy; Cancer Care Ontario Wait Times; MOHLTC WTS Targets; Access to Care Ontario; Access to Care Executive Update newsletter; www.accesstocare.on.ca/.

Other Resources

Access to Care
https://www.accesstocare.on.ca/

Cancer Care Ontario (CCO)
Breast Cancer Screening
Colon Cancer Screening
Cancer Care Ontario Wait Times
Access to Care Ontario
Access to Care Executive Update newsletter

Canadian Medical Protective Association (CMPA)
CMPA Good Practices Guide

College of Physicians and Surgeons of Ontario (CPSO)
CPSO Clinical Practice Guidelines
Out-of-Hospital Premises Inspection Program (OHPIP): Download PDF

Health Quality Ontario (HQO)
HQO Website - www.qhontario.ca
HQO Surgical Quality Improvement Network
HQO Quality Compass - Quality Improvement

Improving & Driving Excellence Across Sectors (IDEAS)
A partnership of Health Quality Ontario, ICES, IHPME and six Ontario universities.
IDEAS Ontario website
Introductory Quality Improvement Program

Institute for Clinical Evaluative Sciences (ICES)
ICES website - www.ices.on.ca

MOHLTC
MOHLTC Wait Time Strategy
MOHLTC WTS Targets

Royal College of Physicians and Surgeons of Canada (RCPSC)
RCPSC: Canadian Medical Education Directives for Specialists (CanMEDS) website