Governance for Quality and Patient Safety: The Impact of the Ontario Excellent Care for All Act, 2010

Abstract

The passage of the Excellent Care for All Act, 2010 (ECFA Act) in Ontario has confirmed the responsibilities of hospital boards for quality of care and reinforced expectations that they will monitor performance and establish strategic aims in this area. Quality of care and patient safety have created a new agenda for many healthcare boards that had only a limited focus on these issues. Here, we report on interviews with five Ontario healthcare organizations identified by experts as having high-performing boards. Our question was, how has the ECFA Act influenced Ontario healthcare organizations' governance practices relating to quality and safety? While the act has raised the profile of these issues, in the short-term it may have blunted the effectiveness of some boards that had already developed a clear strategic focus on quality and patient safety. Executive compensation was the most contentious issue; the introduction of pay for performance was considered poor timing, given the Ontario government's pay freeze. Overall, the act is an important step in increasing responsible governance and has helped align governance activities with the core work of hospitals-delivering high-quality care. However, effective policy must create an environment where all organizations focus on improvement, but where regulation does not limit the capabilities of leading organizations to achieve even higher performance. Visit the Ministry of Health and long-term care www.health.gov.on.ca

The contribution of case study research to knowledge of how to improve quality of care

“…More broadly, case study research provides methods to examine organisational processes over time, examining the interplay of interventions with team dynamics or leadership strategy. For example, studies by Baker30 and Bate31 of high-performing healthcare organisations illustrate the challenges of creating, spreading and sustaining effective practice in organisations. Some case study research has followed organisations over extended time periods repeating interviews with key informants (eg, Denis' work on strategic change40 41).…”

Nursing Practice in Primary Care and Patients’ Experience of Care

“…The literature offers abundant evidence of the importance of primary care in improving the management of people’s health. 1 - 4 Studies have increasingly highlighted nurses’ and particularly registered nurses’ fundamental role in patient management and follow-up. 5 - 10 In primary care, nurses’ activities can be grouped into several sets of activities.…”

Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study

“…41 Acceptance for change can be influenced by the origin of the decision being either 'top down' or 'ground up'. [41][42][43] This apparently becomes more of an issue if the change challenges the professionalism norms in relation to work and caring ethics, and values shared within the group. 23 Problems with the implementation can also be linked to difficulties in sharing information within the organization and the heavy workload described in this case.…”