Ontario primary care reform and quality improvement activities: an environmental scan

Abstract

BackgroundQuality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province.MethodsData were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process.ResultsThe environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked.ConclusionsWithin the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

A Review and Synthesis of TBPCC Evaluation in Canada: Looking beyond the Quadruple Aim

“…Common barriers to collaboration and team function include the time it takes to build relationships, the lack of opportunities for co-location, and challenges with role definition (59,64,66). Despite some studies that suggest only moderate success in the context of interdisciplinary collaboration (63,74), there is ample evidence of the importance of working to develop shared values in primary care teams and the value of efforts to improve group dynamics to support higher levels of interdisciplinary collaboration (5,44,(74)(75)(76). Working to build understanding of roles and shared leadership is also widely attributed to enhancing collaboration (58,60,61,65).…”

“…This included determining team members' scope of practice, boundaries, and role responsibilities(56,(58)(59)(60). Other related themes included: changes in screening and prevention care (61); provider and patient experience with quality of care(50); funding related impacts on team function(52,62); support for information technology, leadership, and education(52,(63)(64)(65); and physical space or co-location(59,66). One study explored patient and provider satisfaction and relationship building(40).…”

Amalan Penambahbaikan Kualiti Berterusan Dalam Institusi Pendidikan

“…Usaha penambahbaikan kualiti yang berterusan ini harus dilihat sebagai strategi pengurusan organisasi dengan objektif untuk meningkatkan proses kerja yang bertujuan untuk memberikan perkhidmatan yang lebih berkualiti kepada pelanggan (Sibbald, McPherson & Kothari, 2013). Malah analisis daripada kajiankajian terdahulu menunjukkan bahawa terdapat hubungan yang positif antara strategi penambahbaikan kualiti, persepsi pengurusan, penglibatan pelanggan, penambahbaikan kualiti maklumat bagi mewujudkan ketekalan daya persaingan yang menguntungkan organisasi ke arah mencapai status kualiti yang tinggi (Goetsch & Davis, 2013).…”

The use of the environmental scan in health services delivery research: a scoping review protocol

“…Environmental scans have been used as an effective approach to information gathering for a range of specific purposes (table 1). These include reviewing the current state of services and programmes, evaluating community and patient needs, identifying service gaps, assessing professional education and training needs, supporting quality improvement initiatives, and informing programme and policy development 12 31 37–59. For instance, environmental scans have been used to assess remote symptom support training programmes for nurses in ambulatory oncology programmes56 and to describe paediatric navigation models across Canada 39…”

“…Despite the wide adoption of environmental scans within the healthcare sector,12 31 37–59 there is no consensus on a working definition or conceptual framework specific to health services delivery, and methodological guidance on the design and implementation of this approach to guide research and practice is lacking in the literature 12 29–31 45. Various terminologies have been used to describe the concept.…”