Collaborating for Excellence in

Healthcare Quality (CEHQ)

Dr. Jack Kitts

President and CEO

The Ottawa Hospital (TOH), Ottawa, ON

Maura Davies

President and CEO

Saskatoon Health Region, Saskatoon, SK

Chris Power

President and CEO

Capital Health, Halifax, NS

June 6, 2011

• 1 in 13 patients admitted to acute-care hospitals in

Canada experience one or more adverse events

• About 37% of these adverse events were highly

preventable

• It is estimated that somewhere between 10,000-

24,000 patients die each year in Canadian hospitals

as a result of preventable adverse-events.

Canadian Adverse Events Study

(R. Baker et al. 2004)

Facts

Questions

1. Does our hospital/health region deliver high quality

care?

2. How do we know we deliver high quality care?

• Access

• Efficiency

• Effectiveness

• Safety

• Patient experience

External Review 2008-2009

“Organizational Factors Associated with High

Performance in Quality and Patient Safety in

Academic Medical Centers”, Academic Medicine,

2007

Goal: The Ottawa Hospital

• To become a Top 10% Performer in Quality and

Patient Safety in North America

How will we know that we are there?

Create a National Collaborative for Excellence in

Health Care Quality (CEHQ)

What is the CEHQ?

• 11 Health Care Organizations

• 4 partners:

• CIHI

• CPSI

• CHSRF

• Accreditation Canada

Participating Organizations

• Alberta Health Services, Edmonton, Alberta

• Capital District Health Authority, Halifax, Nova Scotia

• University Health Network, Toronto, Ontario

• McGill University Health Centre, Montreal, Quebec

• Winnipeg Regional Health Authority, Winnipeg, Manitoba

• Saskatoon Health Region, Saskatoon, Saskatchewan

• Vancouver Coastal Authority, Vancouver, British-Columbia

• St. Michael’s Hospital, Toronto, Ontario

• Eastern Regional Integrated Health Authority, St. John’s, Newfoundland

• Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec

• The Ottawa Hospital, Ottawa, Ontario

Mandate of CEHQ

• Attain higher quality of care through collaboration

• Create common performance measures

• Benchmark with each other

• Share experience in Quality Improvement initiatives

• Create a template for a quality plan

• Conduct health system research

Why is my organization participating?

AccomplishmentsAt our April meeting we:

�Agreed upon 16 indicators, in 5 key areas, to be the basis of our Quality Scorecard

�Shared our best practices, lessons and challenges in our Quality Improvement Initiatives

�Reviewed the plan for the Guide to Developing an Effective Quality Plan which will be ready for the Fall meeting

�Agreed to participate in a common research project - the Canadian Avoidable Readmissions Study (CARS)

Creating a

Common Quality Scorecard

• Currently 521 quality indicators measured

• Different definitions, little comparability

• Agreed on five dimensions,16 indicators

for shared quality scorecard

Quality ScorecardQuality Scorecard

Effectiveness

Efficiency

Readmission rate overall (all

causes)

Cost per weighted case

Actual vs. expected length of

stay

Safety

MRSA

CDI

VRE

Surgical safety checklist

Surgical site infection (SSI)

HSMR

Pressure ulcers

Satisfaction / Patient

Experience

Inpatient satisfaction/

experience (overall)

Access

Wait times for DI (MRI/CT)

Surgical wait times

Wait times in ED

Delay to hip fracture surgery

% success rate of organ

donation

% ALC cases and days

Quality Improvement Initiatives

• Lead at least one major organization-wide

quality improvement initiative over 3 years

Criteria:

• System-wide

• Comprehensive

• Meaningful in improving the organization

• Standard template

• Use of any quality improvement methodology

Quality Improvement InitiativesQuality Improvement InitiativesOrganization Title

Alberta Health

Services

Alberta Health Services Safe Surgery Checklist

Capital District

Health Authority

Pressure Ulcers in Hospitalized PatientsSurgical Checklists

Centre hospitalier

universitaire de

Sherbrooke

Medication reconciliation

Eastern Health Electronic Occurrence Reporting and Strengthening the Safety Culture

McGill University

Health Center

Catheter-related Blood Stream Infections

Quality Improvement InitiativesQuality Improvement InitiativesOrganization Title

Saskatoon Health

RegionReleasing Time to Care™

St. Michael's Hospital Patient access and flow optimizationHand Hygiene

The Ottawa Hospital Medication ReconciliationOrganizational-Wide System for Responding to Complications of Care and Medical Errors

University Health

NetworkHand Hygiene

Vancouver Coastal

HealthHand Hygiene

Winnipeg Regional

Health AuthorityReporting of Critical Incidents and Improving Safety Culture

Developing an Effective Quality Plan

TemplateBackground

• Greater emphasis on Board and system accountability

• Mandatory public reporting of quality indicators in

some provinces

• Many organizations creating quality plans

• Few standards or guidelines for quality plans

• One designate from each CEHQ organization

• Consultation, input and draft review through

teleconference, round tables and online discussions

Deliverables

• User-friendly guide to developing a quality plan that is

flexible and adaptable to organizations of different size,

focus and/or at different places in the evolution of their

quality journey.

• Guide will include:

• Suggested format and structure for a quality plan

• Guidelines on content, organization and level of

detail

• Examples and tools to assist in the development of a

quality plan

Draft Table of Contents for Guide • Introduction

– What is a quality plan?

– Why is it important to develop and implement a quality plan?

• Principles

• Components – Description of components

– Example of a Quality Plan Worksheet

• Reporting Mechanisms

– Characteristics of an Effective Reporting Mechanism

– Stakeholders

– Reporting Formats

• Appendices

– Examples of Organization Quality Plans and Reporting Mechanisms

What is CARS?

• Proposed research study to CIHR - $1.7 million

• Multi-center prospective study

• Goals:

• Define ‘avoidable’ readmissions

• Identify causes for ‘avoidable’ readmissions

• Develop/refine indicators for ‘avoidable readmissions

• Method: Cases in which patients are readmitted will be

reviewed in a standard fashion to determine reason,

including avoidability

Why are we collaborating to identify

avoidable readmissions?

• Unplanned hospital readmissions in United States in 2003/2004 were estimated to cost $17.4 billion annually

• That number ballooned to $25 billion in 2008

• The cost of unplanned readmissions in Canada is unknown

Role of Collaborative within CARS

• Conduct an inventory of Discharge Processes to prepare for the CARS study

• Moral support for CARS

CARS Research TeamA – Susan

Kahn

B – William

Ghali, Elijah

Dixon

C – Sharon

Card

D – TBD

E - Irfan

Dhalla, Brian

Golden,

Dante

Morra

F – Alan Forster,

Carl van

Walraven, Claire

Kendall, Chantal

Backman,

Monica Taljaard

G – Robyn

Tamblyn, Ari

Meugurditchian

H – Marie-France

Hivert,

I – Marc

Borgaonkar

J – Jafna Cox

A B CD

E

FGH

I

J

Next StepsNext Steps

• Work with CIHI to complete the Scorecard

• Complete Quality Plan Template

• Form subgroups to identify areas for improved collaboration and reporting among our organizations

• Conduct inventory of Discharge Processes for the CARS study

• Update provincial Ministers and Deputy Ministers, and Federal Minister

• Improve education opportunities for the Collaborative

• Meet again in November