Path2Quality Mem5Y report - OAP · OAP Board and Lab Medicine Section Committee members to gather...

Blueprint for Quality, Architect of Success

Blueprint for Quality Architect of Success

Path2Quality

5 Y E A R R E P O R T : 2 0 0 9 – 2 0 1 4

Ontario Association of PathologistsSection on Laboratory Medicine

© Path2Quality 2014

All rights reserved. No part of this publication may bereproduced, in any form or by any means without theprior written permission of Path2Quality - a partnershipof the OMA Section on Laboratory Medicine and theOntario Association of Pathologists.


Introduction ................................................................................................................ 4

2013 – 2014 Path2Quality Executive ........................................................................ 5

Values and Goals .......................................................................................................... 6

From Vision to Action in 5 Short Years ...................................................................... 7

Knowledge Generation .............................................................................................. 8

Knowledge Dissemination / Building Leadership Capacity .................................. 9

Advocacy / Strengthening the System of Patient Care ............................................ 10

Membership Engagement .......................................................................................... 11

Our Future – Building on Success ............................................................................ 12

Path2Quality Governance Structures ........................................................................ 13

Path2Quality Executive (Effective May 2, 2014): Appendix 1 ................................ 17

Path2Quality Advisory Board (Effective May 3, 2014): Appendix 2 ...................... 18

Chronology of Path2Quality Activity: Appendix 3 .................................................. 19

Contents

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Path2Quality – Five Year Report: 2009-2014

It is with great pleasure that we presentPath2Quality’s 5-Year Report.

In five short years, the Path2Quality (P2Q)group has established a model of profes-sional collaboration that is highly regardedby the profession, the Ministry of Healthand Long Term Care as well as other healthcare organizations. These key stakeholderslook to P2Q members for guidance onquality, resource and other professional andpatient care issues. Path2Quality’s credibilityis attributable to the unique resources andtools it has developed to support the workof Ontario’s laboratory physicians.

Our Standards2Quality Guidelines docu-ment (S2Q) has been endorsed by thePathology Services Expert Panel of the newCPSO / CCO Quality Management Part-nership (QMP) and is currently being usedas a foundational document in thisinitiative. It goes without saying that implementation of quality guidelines iscontingent upon provision of additionalrequired resources.

Our Workload2Quality Guidelines (W2Q)have been trialed and found to be a reliableassessment tool for determining the appro-priate level of professional resourcesrequired to support the provision of highquality laboratory medicine service inOntario.

These documents are being used not onlyby facilities in the province but have alsobeen requested by other jurisdictions in thecountry. They become important referencesfor quality assurance initiatives in anysector.

A sustainable, patient-centric, comprehensivelaboratory medicine service that wouldsupport “The Excellent Care For All Act”is possible only when a dedicated approachis undertaken to create local, regional andprovincial networks for delivery of theseservices. This is the concept behind acurrent work-in-progress, Networks2Quality(N2Q). Equally important is developmentof a robust and accountable framework of medical leader-ship which is the

focus of another work-in-progress,Leadership2Quality (L2Q).

It has been suggested at one of theLaboratory Medical Directors’ Summitsthat the utilization issues in laboratorymedicine within the context of appropriateordering of tests could be addressed at theprovincial level as a multi-stakeholderinitiative. As laboratory physicians, we arebest positioned to promote the concept ofUtilization2Quality (U2Q) which couldyield high quality and fiscal dividends!

We would like to take this opportunity tothank our entire executive team, Councilmembers of the OMA Section on LaboratoryMedicine and Board members of theOntario Association of Pathologists for theirdedication and unflinching vision andsupport in this endeavour. Thanks are alsoextended to members of our respective organizations for their feedback, supportand participation which have helped tomake this undertaking a success. Our appreciation and thanks also go out to Ms.Kathy Bugeja for her exceptionalconsulting advice and assistance.

Introduction to the Path2Quality 5-Year Report

Dr. Suhas B. JoshiOMA Section on Laboratory Medicine

Dr. David ShumOntario Association of Pathologists

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Suhas B. Joshi, MD FRCPCChair, OMA Section on Laboratory MedicineCo-Chair Path2Quality

C. Meg McLachlin, MD, FRCPCPast Chair, OMA Section on Laboratory Medicine

K. Niki MacNeill, MD, FRCPCVice Chair, OMA Section on Laboratory Medicine

Russell Price, MD, FRCPCVice President, Ontario Association of Pathologists

Satish Chawla, MBBS, FRCPC Secretary-Treasurer, Ontario Association of Pathologists

Katherine A. Chorneyko, MD FRCPCPast President, Ontario Association of Pathologists

Terry Colgan, MD, FRCPCSecretary-Treasurer, OMA Section on Laboratory Medicine

David T. Shum, MB FRCPCPresident, Ontario Association of PathologistsCo-Chair Path2Quality

J Brendan M. Mullen, MD FRCPCTariff Committee Chair, OMA Section on LaboratoryMedicine

2013 – 2014 Path2Quality Executive

5

Who we arePath2Quality (P2Q), the collaborative betweenthe OMA Section on Laboratory Medicine andthe Ontario Associationof Pathologists.

Our MissionAttain the highest levelsof patient care and safetyin Ontario, through thepromotion and/or development ofinitiatives that enhancethe systems, environmentsand resources thatsupport the work ofOntario’s laboratoryphysicians.

Our VisionA comprehensive,integrated, high quality,laboratory medicinesystem, supported byappropriate resources,that is the benchmark for professional andpatient satisfaction inCanada.


Values and Goals

Our ValuesFrom a patient standpoint, Ontario’ssystem of laboratory medicine must:

• Be patient-centered, maintain clinicalcoherence and continuity of care;

• Consistently deliver the timely, relevantand reliable information that supportsclinical decisions;

• Engender the highest levels of patientconfidence and safety.

From a professional standpoint, Ontario’ssystem of laboratory medicine must:

• Be developed and led by laboratoryphysicians in consultation with majorstakeholders;

• Be integrated, comprehensive, flexible,and appropriately resourced to provideappropriate laboratory medicine serviceswithin community, regional and tertiarycentres, while respecting local work en-vironments and cultures;

• Embody a quality system that is guidedby best practice and best evidence;

• Incorporate Standards2Quality and Work-2Quality principles as articulated inthose two respective guideline documents;

• Foster professional satisfaction that in-cludes financial stability, predictabilityand work-life balance;

• Promote innovation and leadership amongOntario’s laboratory physicians;

• Maintain the principle of self-regulationfor laboratory physicians;

• Promote a respectful and productiveworking relationship between Ontario’slaboratory physicians and key stakehold-ers / influencers of the system as it relatesto the practice and delivery of laboratorymedicine services in the province.

Key Goals• Build on efforts that position P2Q as theconsolidated, respected voice of theprofession representing the needs andinterests of Ontario’s laboratoryphysicians and their patients.

• Be the driver of change influencing thepractice, delivery and quality man-agement of laboratory medicine servicesin Ontario.

• Transform Ontario’s laboratory medicinesystem to achieve the highest levels oflaboratory physician satisfaction inCanada.

• Build public confidence and support forthe profession and the vital services theyprovide.

• Build leadership capacity within theprofession.

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From Vision to Action in Five Short Years

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• Knowledge Generation

• Knowledge Dissemination/Building LeadershipCapacity

• Advocacy /Strengtheningthe System ofPatient Care

• MembershipEngagement



Knowledge Generation

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Networks2Quality

Work-in-Progress.

Issued in September 2013, Version 2now includes sections on cytopath-ology and hematopathology and hasbeen updated throughout to reflectthe evolution in best practice forpathology.

Released in 2011, Standards2Quality:Guidelines for Quality Managementin Surgical Pathology ProfessionalPractices, articulate the basic policiesand procedures that should be inplace in a quality managementprogram to govern the medicalprocesses of professional pathologicinterpretation, including cancerdiagnosis.

Standards2Quality

A unique, made-for-Ontarioworkload measurement system for laboratory medicine professional practice that wasdeveloped and released in 2012.

Work2Quality

Standards2Quality Version 2

Leadership2Quality

Work-in-Progress.



Knowledge Dissemination / Building Leadership Capacity

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W2Q Poster presentation at Fall 2013 CAP S2Q Poster presentation

at Fall 2013 CAP

“The Future of Laboratory Medicine:A Symposium for Generation X / Y Lab

Physicians”

A special full day session held in 2012 toshape and support future leaders in

Ontario’s laboratories

Ontario Laboratory Directors’ SummitsMaximizing Quality /

Mitigating Risk in Your Lab

Semi-annual ½ day sessions held since 2010that are designed to impart new knowledgeand promote dialogue among Ontario’s lab

leaders

May 2010: Overview of QA oversight in Ontario –Debut of Path2Quality

Nov 2010: Results of Lab Directors’QA Survey – Standards2Quality (S2Q)

project introduced

June 2012: June 2012:debut of Work2Quality(W2Q) document: QA

presentations (OFPS, QMP-LS)

Dec 2012: Leadership2Qualitysurvey results; S2Q and W2Qupdate; overview OMA Physician

Health Program

Dec 2011: P2QUpdate; redesign ofCPSO peer reviewprocess; LEANapplication in

Kitchener-Waterloo

June 2011: Standards2Qualityguidelines document presented; MOHTLC Expert Panel overview; QA presentations: Eastern Canada

Initiative; Teamwork and Collaborationin Health Care

May 2014: Update – CPSO / CCO QualityManagement Partnership; Impact of HospitalService Redistribution / Outsourcing to the

Community; 2014-2015 OMA Section Priorities

“Clarifying Roles, Responsibilitiesand Critical Elements in QualityManagement Systems as Appliedto the Professional Work of

Ontario’s Laboratory Physicians”

Key stakeholder symposiumorganized by Path2Quality in

November 2009



Advocacy / Strengthening the System of Patient Care

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February 4, 2014 consultationbetween CPSO / CCO QMP andOAP Board and Lab MedicineSection Committee members togather input and test QMPassumptions and potentialframework for pathology

Ministry of Health and LongTerm Care Pathology Services

Expert Panel Report

Path2Quality was a primestakeholder in this Ministryinitiative whose report was

released in 2013. P2Q input andadvice shaped Ministry directions

moving forward

May 2013 Meeting with Drs. Rocco Gerace and

Michael Sherar, Co-Chairs of theCPSO / CCO Quality

Management Partnership toexplore mandate of QMP andexpress physician concerns and

expectations

“Clarifying Roles, Responsibilitiesand Critical Elements in QualityManagement Systems as Appliedto the Professional Work of

Ontario’s Laboratory Physicians”

Key stakeholder symposiumorganized by Path2Quality in

November 2009

CPSO / CCO QualityManagement Partnership(QMP): Pathology ServicesExpert Panel (2013 – 2015):Members of the OMA Sectionand the OAP are participating in

the Expert Panel



Membership Engagement

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OAP Website and Blog: affordsreal-time physician feedback onkey issues affecting their practice

Nov 2012: Leadership2Qualitysurvey on current roles and

responsibilities

July 2012: Work2Quality draftissued for input and advice

January 2011 – feedback soughton draft Standards2Qualityguidelines document

Spring 2009 – general survey re QA concerns, best practices:

results informed development of P2Q

June 2013 – feedback sought onMOHLTC Expert Panel Report:

results informed strategy re: CPSO /CCO Quality Management

Partnership

Ontario Laboratory Director Surveys

Membership / Laboratory Physician Surveys

OMA Section on LaboratoryMedicine Member Communications:average 25 / year to all laboratoryphysicians in the province. Providesinformation and seeks input on keyissues affecting their practice includingPath2Quality updates, Lab DirectorSummit and special event highlights;

MOHLTC initiatives, etc.

Oct 2010: Current state analysis of QApractices in hospital labs: results informed the

development of Standards2Quality


Our Future – Building on Success

12

Laboratory physicians leading the design of a new paradigm in laboratory medicine care and service delivery in Ontario

(Networks2Quality – N2Q)

Supported by:

• Stable funding system (an Alternate Payment Plan-like plan) that supportsclinical coherence and regional models of care

• Bilateral mechanism between the OMA and the MOHLTC to addressissues relevant to the provision of quality care in Ontario

• Comprehensive, integrated, highquality system that is flexible andsupports the provision oflaboratory medicine services in allsettings

• Promotes patient satisfaction,confidence and security

• Ongoing advocacy for patients and the profession

• Continued knowledge transferinitiatives

• Practice environments that supportand encourage innovation andleadership among Ontario’slaboratory physicians(Leadership2Quality – L2Q)

• Address the changing deliverylandscape and Ministry goals andobjectives

• Continue creating new or updatingpublished documents (S2Q, W2Q)


Path2Quality Governance Structures

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Path2Quality ExecutiveCommitteeGuiding the work of Path2Quality is itsExecutive Committee comprised of

• The Executive, OMA Section onLaboratory Medicine including theChair, Vice Chair, Past Chair, Secretary-Treasurer and Tariff Chair.

• Officers of the Ontario Association ofPathologists including the President, VicePresident, Past President and Secretary-Treasurer.

The Chair of the OMA Section onLaboratory Medicine, together with the President, Ontario Association of Pathologists serve as Co-Chairs of the P2QExecutive Committee.

The Path2Quality Executive Committeereports to its two founding organizations,the OMA Section on Laboratory Medicineand the Ontario Association of Pathologiststhrough their designated representatives.

P2Q reports to the broader membership ofthe founding organizations semi-annuallythrough:

• The OMA Section on LaboratoryMedicine’s Annual General Meeting(Spring); and

• The Ontario Association of Pathologists’Annual General Meeting (Fall).

The Grand Assembly for the retreat in September, a day prior to the OAP AGM and ScientificSessions at Collingwood. In attendance were the OMA Section on Laboratory Medicine ExecutiveCommittee, Tariff Committee and Council Members and Ontario Association of PathologistsExecutive Committee and Board Members.

From left to right:Dr. Satish Chawla, Dr. Russell Price, Dr. Hudson Giang, Dr. David Hwang, Dr. John Srigley, Dr. David Shum, Dr. Virginia Walley, Dr. Brendan Mullen, Dr. Kathy Chorneyko, Dr. Murray Treloar, Dr. Meg McLachlin, Dr. Niki MacNeill, Dr. Adrian Batten, Dr. ChristinaMacMillan, Dr. Suhas Joshi.

Path2Quality Executive at their September 19, 2013 retreat in Collingwood.

From left to right front row: Dr. John Srigley, Past President OAP; Dr. Kathy Chorneyko,President OAP; Dr. Christina MacMillan, Secretary-Treasurer OAP; Dr. Suhas Joshi, Chair ,OMASection on Laboratory Medicine.

From left to right back row:Dr. Meg McLachlin, Past Chair, OMA Section on LaboratoryMedicine; Dr. David Shum, Vice President OAP; Dr. Brendan Mullen, Tariff Chair, OMA Sectionon Laboratory Medicine; Dr. Niki MacNeill, Vice Chair, OMA Section on Laboratory Medicine.

Attended but not in picture: Dr. Terry Colgan, Secretary-Treasurer, OMA Section on LaboratoryMedicine.


Path2Quality Advisory BoardThe Path2Quality Executive Committee issupported by its Advisory Board which iscomprised of peer leaders and pastExecutive of its founding organizations.

At the request of the P2Q Executive, theAdvisory Board provides periodic input,advice and expertise critical to the work ofthe collaborative.

Members of the P2Q Advisory Board mayalso participate within the StandingCommittees of Path2Quality.

Path2Quality StandingCommitteesTo help carry out its work, Path2Qualityhas created standing committees, whosemembers are drawn primarily from theOAP Board and the Section’s Executive,Council and Tariff Committees. Thesecommittees report directly to the Path2-Quality Executive Committee. A descriptionof each Standing Committee is providedbelow.

Standards2Quality (S2Q) Standards2Quality: Guidelines for QualityManagement in Professional PathologyPractices, articulate the basic policies andprocedures that should be in place in aquality management program to govern themedical processes of professional path-ologic interpretation, including cancerdiagnosis. Referred to as a ‘living docu-ment’, S2Q, has already been revised sinceits initial release in 2011. Version 2, issuedin September 2013 now includes sectionson cytopathology and hematopathologyand has been updated throughout to reflectthe evolution in best practice for pathology.

The S2Q Standing Committee is responsiblefor the following:

• Regular review of the S2Q Guidelinesrevising, where required to ensure theguidelines always provide the best adviceon quality management programs to support the professional work ofOntario’s laboratory physicians.

• Help identify and / or develop standardsand benchmarks against which per-formance may be measured.

• Help develop an evidence base for provincially-agreed-upon professionalstandards or benchmarks for suchperformance measurement.

• Help identify future foci for Path2Qualitythat support the professional work ofOntario’s laboratory physicians.

• Provide input and advice via P2Q tothose key stakeholder groups who areworking with the S2Q Guidelines.

Work2Quality (W2Q) One of the key quality requisites articulatedin the S2Q Guidelines centers on the abilityto identify the human resource and infra-structure supports that are required tosupport a quality management program forpathology. That is the focus of the Work2-Quality (W2Q) Guidelines, a unique, made-for-Ontario workload measurement systemfor laboratory medicine professional practicethat was developed and released in 2012.Designed to take into account a number offactors of interest to laboratory physiciansin Ontario and to recognize the uniqueenvironment in which they work, the W2QGuidelines remain the only yardstick forworkload measurement in the province.


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Similar to the S2Q Guidelines, it isanticipated that the W2Q Guidelines willevolve over time, to appropriately reflectcontemporary laboratory medicine practicein Ontario.

The purpose of the W2Q StandingCommittee, therefore, is to:

• Receive and regularly review thosecomments and suggestions frommembers received through the OMASection and the OAP, and make modifi-cations to the W2Q Guidelines as arerequired over time.

• Identify potential strategies that could beemployed to get the W2Q Guidelinesendorsed by key stakeholder groups whoinfluence the practice of laboratorymedicine.

Leadership2Quality (L2Q) Consistent with P2Q’s goals of buildingleadership capacity within the profession,there is the need to identify and cultivatethe leadership skills and qualities thatsupport a comprehensive, integrated, highquality, laboratory medicine system. Thatis the focus of the Leadership2Quality(L2Q) Committee which is responsible forthe following:

• Review existing leadership roles inlaboratory medicine, e.g., laboratorydirector, chief of department, head ofsection, head of discipline, lead forquality etc. – and the function and re-sponsibilities associated with these roles.

• Within the context of an evolving quality-focused laboratory medicine network ofcare, identify the future skills, perspec-

tives and experience required of theselaboratory leaders in order to meet the ex-pectations placed on them.

• Conduct a gap analysis. Compare currentrole definitions and responsibilities oflaboratory leadership against these futurerequired skills, perspectives andexperience in order to determinepotential gaps that need to be addressed.

• Identify and make recommendations onthe support requirements and processesneeded by these leaders to address thesegaps.

• Identify opportunities or programs thatcould be developed to promote individualskills development / self-learning withinthe pathology community in general.

• Customize the leadership framework tomeet the needs of a medical laboratorywithin the context of size, sites, mandateand complexity of the organization.

Networks2Quality (N2Q)Rapid changes in health care planning andservice delivery, coupled with increasingdemand and expectations placed on theprofession, warrant delivery models that arerobust, flexible and responsive. One sizedoes not fit all. That is the underlyingpremise of Networks2Quality which isenvisioned to create a patient-centric,quality-focused, seamless laboratory medicine system that maintains continuityof care and clinical coherence.

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Within this context, the Networks2Quality(N2Q) Committee is envisioned to pursuethe following:

• Map how laboratory medicine servicesare currently provided across Ontariotaking into account the current intra-laboratory / referral relationships thatexist.

• Provide professional input and guidancewith respect to potential changes thatcould affect the laboratory medicinepractice environment.

• Determine the impact on staffing andclinical coherence arising from:

• Regionalization initiatives within theLHINs;

• Service-redistribution of hospital-based services (e.g., endoscopy andcolonoscopy) to Community–BasedSpecialty Clinics (CBSCs) or toIndependent Health Facilities(IHFs);

• Shifts in hospital-based fundingfrom global funding to Quality-Based Procedures funding,

• Other changes as identified by theN2Q Committee or P2Q

• Design an ideal network of laboratorymedicine services within the provincethat supports the development of asustainable, comprehensive, integrated,high quality, laboratory medicine systemin Ontario.

• Develop recommendations (e.g, resourcesand other pre-requisites) that couldsupport the development of this idealnetwork of laboratory medicine serviceswithin the province.

Path2Quality SpecialCommittees / Working GroupsFrom time to time, the Executive ofPath2Quality may create sub-committeesor working groups whose specific focus,membership, terms of reference andduration will be determined by the P2QExecutive.

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Karen N. MacNeill, MD FRCPC

Chair, OMA Section on LaboratoryMedicine; Co-Chair Path2Quality; Chief of Pathology, Royal Victoria RegionalHealth Centre; Lecturer, Department of Laboratory Medicineand Pathobiology, University of Toronto

Suhas B. Joshi, MD FRCPC

Past Chair, OMA Section on LaboratoryMedicine; Chief of Department of Laboratory Medicineand Regional Director of Laboratories,Niagara Health System; Adjunct Assistant Clinical Professor,Department of Pathology and MolecularMedicine, McMaster University

Catherine Ross, MD FRCPC

Vice Chair, OMA Section on LaboratoryMedicine; Pathologist, Hamilton Regional LaboratoryMedicine Program; Associate Professor, Department of Pathologyand Molecular Medicine, McMasterUniversity

J Brendan M. Mullen, MD FRCPC

Chair, OMA Section on Laboratory MedicineTariff Committee; Deputy Director, Department of Pathologyand Laboratory Medicine, Mount SinaiHospital; Associate Professor, Departments ofLaboratory Medicine and Pathobiology,Urology and Anaesthesia, University ofToronto

Terry Colgan, MD FRCPC

Secretary-Treasurer, OMA Section onLaboratory Medicine; Head of Sections of Gynecological & Cyto-Pathology, Mount Sinai Hospital;Professor, Laboratory Medicine & Pathobiology, University of Toronto

David T. Shum, MB FRCPC

President, Ontario Association of Pathologists; Co-Chair Path2Quality; Medical Director and Chief, Department of Laboratory Medicine, Windsor Regional Hospital, and LeamingtonDistrict Memorial Hospital; Adjunct Professor, Department of Pathology,Western University

Katherine A. Chorneyko, MD FRCPC

Past President, Ontario Association of Pathologists; Medical Director, Laboratory Services Brantford Community Healthcare Services; Associate Professor, Department of Pathologyand Molecular Medicine, McMasterUniversity

Russell Price, MD FRCPC

Vice President, Ontario Association of Pathologists; Clinical Director of Laboratories, RoyalVictoria Regional Health Centre; Adjunct Assistant Clinical Professor,Department of Pathology and MolecularMedicine, McMaster University

Satish Chawla, MBBS FRCPC

Secretary-Treasurer, Ontario Association ofPathologists;Staff Pathologist; Department of LaboratoryMedicine, Niagara Health System; Adjunct Assistant Clinical Professor,Department of Pathology and MolecularMedicine, McMaster University

Path2Quality Executive (Effective May 2, 2014) Appendix 1

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OMA Section on LaboratoryMedicine

C. Meg McLachlin, MD FRCPC

Past Chair (2010 – 2012), OMA Section onLaboratory Medicine; Program Head, Pathology, London HealthSciences Centre; Professor, Department of Pathology, WesternUniversity

J Brendan M. Mullen, MD FRCPC

Past Chair (2008 – 2010), OMA Section onLaboratory Medicine;Deputy Director, Department of Pathologyand Laboratory Medicine, Mount SinaiHospital; Associate Professor, Departments ofLaboratory Medicine and Pathobiology,Urology and Anaesthesia, University ofToronto

Virginia M. Walley, MD FRCPC

Past Chair (2006 – 2008), OMA Section onLaboratory Medicine;Ontario Medical Director, LifeLabs;Clinical Professor, Department of LaboratoryMedicine and Pathobiology, University ofToronto;Adjunct Professor, Department of Pathologyand Molecular Medicine, Queen’s University

Ontario Association of Pathologists

John R. Srigley, MD FRCPC FRCPATH

FRCPA (Hon.)

Past President (2009 – 2011), OntarioAssociation of Pathologists;Chief and Medical Director, LaboratoryMedicine and Genetics Program, TrilliumHealth Partners;Professor, Department of Pathology andMolecular Medicine, McMaster University

Suhas B. Joshi, MD FRCPC

Past President (2006 – 2009), OntarioAssociation of Pathologists; Chief of Department of Laboratory Medicineand Regional Director of Laboratories,Niagara Health System; Adjunct Assistant Clinical Professor,Department of Pathology and MolecularMedicine, McMaster University

Dimitrios Divaris, MBChB FRCPC

Past President (2004 – 2006), OntarioAssociation of Pathologists; Joint Chief of Pathology and Medical Directorof Laboratory Medicine GRH and SMGHCCO Clinical Lead, Pathology and ReportingStandards; LHIN3 CCO Pathology Lead

Murray Treloar, MD FRCPC CCPE

Past President (1999 – 2002), OntarioAssociation of Pathologists; General Pathologist, Gamma-DynacareMedical Laboratories & Lakeridge Health-UHN;Lecturer, Part-time, Department ofLaboratory Medicine and Pathobiology,Faculty of Medicine, University of Toronto

Member-at-large (Peer Leader)

Diponkar Banerjee, MBChB FRCPC PhD

Head, Division of Anatomical Pathology,Eastern Ontario Regional LaboratoryAssociation, and The Ottawa Hospital;Regional Pathology Lead, Cancer CareOntario; Professor of Pathology and LaboratoryMedicine, University of Ottawa

Sandip K. SenGupta, MD FRCPC CCPE

Past President (1997 – 1999), OntarioAssociation of Pathologists; Medical Laboratory Director & Deputy Head,Dept. of Pathology & Molecular Medicine,Kingston General Hospital & Hotel DieuHospital; Professor of Pathology and Oncology, Queen’sUniversity

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Path2Quality Advisory Board (Effective May 3, 2014) Appendix 2

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Chronology of Path2Quality Activity Appendix 3

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Year Date Description

2008 Spring

2008 June 24

2008 Late Summer

2008 October 3

2008 November

2009 Spring

2009 November 27

2010 April

2010 May 14

Concept of Quality4Pathology involving 4 major stakeholders – OMA Section,OAP, CCO and QMP-LS) was discussed.

Inaugural planning meeting of Quality4Pathology held at Mt. Sinai.

With the emphasis being an organization that represents and advocates for theprofession, Quality4Pathology evolves into Path2Quality with two principal organizations: OMA Section on Laboratory Medicine and the OntarioAssociation of Pathologists.

Concept and draft Terms of Reference for P2Q presented and endorsed at theOAP Board and AGM, Haliburton, Ontario.

Terms of Reference approved.

Members’ survey identified areas of concern / potential focus for P2Q: pathologisterror in reporting; best practices related to the quality of professional interpreta-tion; and workload and staffing.

“Too Much? Too Little? Or Just Right? Clarifying Roles, Responsibilities andCritical Elements in Quality Management Systems as Applied to the ProfessionalWork of Ontario’s Pathologists” - the launching point for P2Q: A symposiumthat brought together the key stakeholders who are currently involved or have aninterest in quality systems as they apply to the professional work of laboratoryphysicians. The symposium fostered a spirit of commitment and collaborationamong symposium participants.

First collaboration begins between Cancer Care Ontario and P2Q with CCOfunding approval of the Standards2Quality project: comprehensive guidelinesfor internal quality assurance, focused on the medical / professional interpretiveprocesses related to surgical pathology.

Guidelines developer job description developed for project.

Inaugural Ontario Laboratory Directors’ and CCO Pathology Leads’ Summit:Maximizing Quality / Mitigating Risk in Your Laboratory. Debut of Path2Qualityincluding mandate, terms of reference. Also presented: Overview of QA oversightin Ontario; Regionalization and Reorganization of Laboratory Services inOntario (Niagara Region and EORLA); Highlights November 2009 StakeholderSummit; Case Study and Panel Discussion – What to Do if Your Lab ComesUnder the Microscope.

Blueprint for Quality, Architect of SuccessBlueprint for Quality, Architect of Success

Path2Quality – Five Year Report: 2009-2014 20



2010 June 1

2010 June 5

2010 June 9

2010 June 23

2010 August 6

2010 September 15

2010 October

2010 October

2010 November 3

2010 November 4

2010 November 26

Guidelines Developer, Barbara Lemay, contracted (June 1st) and work begins.

Inaugural meeting of Standards2Quality (S2Q) Steering Committee to setparameters. (Mt. Sinai Hospital)

Quality Summit – Toronto. Discussed S2Q project.One page descriptor of S2Q project launched to media via OMA Public Affairs.

Windsor Final Report circulated

P2Q letter to the Honorable Health Minister Deb Matthews post-Windsor reviewemphasizing P2Q element of Windsor review recommendations.

P2Q Co-Chairs’ meeting with OHA and CPSO.

Current state analysis survey issued to Ontario Laboratory Directors to assess thelevel of activity / resources that are currently being devoted to quality assurancepractices related to professional interpretation in anatomic pathology, specificallysurgical pathology. Survey sent to 84 hospital laboratories in Ontario. 90%response rate. Results used by S2Q Steering Committee to help informdevelopment of S2Q project.

Draft policies assigned, reviewed and revised by members of S2Q Committee

Section members’ mailing: First call for participants for Workload2Qualityproject.

S2Q Steering Committee meeting at The Credit Valley Hospital. Reviewed QApolicies: External Consult, Intradepartmental Consultation/Review, IntraoperativeConsultation, Previous Surgical / Cytology Material, Retrospective Review,Turnaround Times

P2Q Laboratory Directors’ QA survey developed and circulated to recipientsshortly thereafter.

Laboratory Directors’ Summit – Results of Laboratory Directors’ QA practicessurvey presented as well as Standards2Quality project. Other topics at Summit:Panel Update on Surgical and Pathology Issues in Windsor: Digital PathologyPresentation by Dr. Christian Couture.


Blueprint for Quality, Architect of Success 21


2011 Jan-Feb

2011 February

2011 March

2011 March 31

2011 June 10

2011 June

2011 December 2

Final draft version developed for peer review and Section members’ feedback.

External peer review conducted. Peer review group represented a selection ofnational and international experts with an interest in, and knowledge of, thevarious quality management programs in place for surgical pathologists both inCanada and in other jurisdictions. Peer reviewers included: Drs. DiponkarBanerjee (CAP); Brett Delahunt (Chair, Cancer Control New Zealand); PaulMcKenzie (President, Royal College of Pathologists of Australasia); ConorO’Keane (Dean, Faculty of Pathology, Royal College of Physicians of Ireland);Kieran Sheahan (Royal College of Physicians of Ireland); Michael Wells (RoyalCollege of Pathologists of UK); Niall Swan (St. Vincent’s Hospital, Ireland);Raouf Nakhleh (Mayo Clinic, Florida); and Andrew Renshaw (Baptist Hospital,Miami Florida.

Revisions incorporating member and peer reviewer comments made to S2Q forfinal version.

FINAL version released: Standards2Quality – Guidelines for QualityManagement in Surgical Pathology Professional Practices, A Proposal forLaboratory Physicians in Ontario together with covering letter that outlinedthemes, strategic directions and next steps.

Ontario Laboratory Directors’ and CCO Pathology Leads’ Summit –culmination of S2Q project with presentation of Standards2Quality Guidelinesfor Quality Management in Surgical Pathology Practices,

Summit also includes presentations by: Dr. Stephen Raab on Quality Assuranceand Quality Improvement Initiatives: Eastern Health (Newfoundland andLabrador); Quality and Safety: Communication, Collaboration and Teamwork(Dr. Murray Treloar); and an overview of the MOHLTC Pathology ServicesExpert Panel (Dr. Sylvia Asa)

S2Q Guidelines also endorsed by the Quality Committee of the CanadianAssociation of Pathologists at their Annual General Meeting in June, 2011.

Laboratory Directors’ Summit – Update on P2Q initiatives plus: proposedchanges to LMFFA payments and the benefits of organizing as a group (Mr. JimSimpson, OMA Legal Counsel); employing the LEAN “Supermarket Model”and negotiating for new positions in Kitchener Grand River (Drs. Demo Divarisand Brian Cummings); an overview of the proposed redesign of the CPSO’s peerreview process as it relates to the creation of peer assessor networking groups.


Path2Quality – Five Year Report: 2009-2014 22



2011 December

2012 Spring

2012 June 8

2012 June 2

2012 July

2012 Sept-Oct

2012 October 18

2012 November

2012 December 7

2012 December

2013 January

Work2Quality working group struck to develop unique-to-Ontario workloadmeasurement guidelines that balance compensation against what is appropriatewith respect to workload, efficiency and effectiveness. W2Q seen as essential toolfor supporting current and long-term planning of patient care needs, humanresource and training program requirements and effective quality and riskmanagement.

Cytology and hematology working groups struck

The Future of Laboratory Medicine – A Symposium for Generation X/Y LabPhysicians – unique full-day session divided into 2 distinct parts. Part 1 –overview of key organizations (OMA, OAP, CPSO, QMP-LS, Pathology Profes-sional Societies) important for lab physicians. Part 2 – case studies designed toillustrate key issues and concerns prevalent in today’s practice and strategies thatcan be employed to address them.

Overview of the draft Work2Quality guidelines presented by Dr. Virginia Walleyat June 2nd Laboratory Directors’ Summit. Other presentations included anoverview of the Ontario Forensic Pathology Services’ health and safety survey(Dr. Kathy Chorneyko) and current and future directions of QMP-LS andIQMH (Dr. Greg Flynn).

Survey of W2Q sent to lab directors and revisions made based on feedback.

W2Q calculator developed

S2Q cytology and hematopathology work debuts at OAP AGM.

L2Q Survey circulated to Lab Directors

Survey results of Leadership2Quality presented by Dr. Niki MacNeill atDecember 7th Lab Directors’ Summit. Other presentations included an updateon S2Q and W2Q; the implications for laboratories arising from new cervicalscreening guidelines (Dr. Meg McLachlin); and an overview of the OMAPhysician Health Program and resources / help available for physicians experiencing distress.

Pilot site testing of Work2Quality begins. 10 sites ranging from academic to smallcommunity-based centres agree to participate.

Results of W2Q Pilot site trial reviewed


Blueprint for Quality, Architect of Success 23


2013 February

2013 March 29

2013 April 6

2013 May 11

2013 May 29

2013 June-August

2013 July

2013 August

2013 September 3

2013 September 19

2013 October 13

2013 October 14

2014 February 4

2014 February 21

2014 May 2

P2Q made aware of Quality Management Partnership initiative by CPSO andwrite letter to Dr. Gerace (Registrar, CPSO) and Dr. Sherar (CEO, CCO)

CCO/CPSO Quality Management Partnership (QMP) announced by MoHLTC

P2Q executive participates in QMP stakeholders’ symposium

Special OMA Section members’ meeting at OMA held with Drs. Gerace andSherar to discuss QMP.

P2Q executive meet with Dr. Sherar / Dr. Gerace and other QMP leaders todiscuss role of P2Q in QMP.

Survey about MOHLTC Expert Panel Report distributed to all members. Resultsposted on OMA and OAP websites

P2Q participates in selection of QMP clinical lead

P2Q assists in distribution of call for expressions of interest to participate in QMPPathology Expert Advisory Panel. Candidate list provided to CPSO / CCO.

Version 2 of Standards2Quality released and available on OMA Section and OAPwebsites.

P2Q planning session held at Blue Mountain, Collingwood, ON.

Work2Quality (W2Q) – Tailored workload measurement guidelines, and theirusefulness for human resource planning in Ontario poster presented at Collegeof American Pathologists’ meeting in Orlando

Standards2Quality (S2Q) – Demonstrated usefulness of S2Q’s qualitymanagement program guidelines for surgical pathology practices poster presentedat College of American Pathologists’ meeting in Orlando

CPSO / CCO Quality Management Partnership formal consultation withmembers of the OAP Board and Section on Laboratory Medicine Executive,Council, and Tariff Committees to garner feedback on proposed qualityframework for pathology. Both the OAP and OMA Section issue formal responses/ commentary subsequent to consultation

P2Q planning session held in Toronto

Laboratory Directors’ Summit: Update – CPSO / CCO Quality ManagementPartnership; Impact of Hospital Service Redistribution / Outsourcing to theCommunity; 2014-2015 OMA Section Priorities


Dr. Suhas B. Joshi

Chief, Department of Laboratory Medicine

& Regional Director of Laboratories

Niagara Health System, St. Catharines Site

1200 Fourth Ave, St. Catharines, ON L2S 0A9

W: 905-684-7271 x 46510 | F: 905-984-5578

[email protected]

Dr. David T. Shum

Medical Director and Chief,

Department of Laboratory Medicine

Windsor Regional Hospital

1995 Lens Avenue, Windsor, ON N8W 1L9

W: 519-254-5577 x 52340 | F: 519-245-6861

[email protected]

Ontario Association of PathologistsSection on Laboratory Medicine

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Path2Quality Mem5Y report - OAP · OAP Board and Lab Medicine Section Committee members to gather...

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