WHAT IS THE QSV PILLAR?
Through Quality, Safety and Value, we are looking to achieve these goals:
- Understand, evaluate and prioritize quality (outcomes, experience and safety including eliminating preventable harm).
- Readily access data and information and use them continuously to improve our person and family-centred care.
- Offer the people we serve the right care, in the right place, at the right time.
- Improve the physical environment at all our sites.
- Practice “value-based health care”, which prioritizes what matters to the people we serve as a way to drive quality and efficiency.
Why this?
Quality and patient safety, have always been at the core of who we are. Prioritizing a “back to basics” focus on quality and patient safety is critical to making sure we uphold our own high standards. And now, more than ever, we’re also making decisions in partnership with patients and families based on what matters most to each individual. Their health and wellness, but also fears and worries, must become central to decisions about what resources we mobilize to care for them. That’s a person and family-centred approach and it’s also the “value” part of this strategy.
Value-based care is a concept that refers to ensuring that we are prioritizing the care and resources that matter most to the people we serve.
What will change?
Over the next seven years, we will be using data and metrics more and more to help us understand how to maintain and improve our standards for safety, experience, and outcomes. We will be leveraging the Clinical and Systems Transformation (CST) Project to make data easy to find and easy to use. In the next seven years we will also be designing and building a care campus, medical centre and hospital (The New St. Paul’s!) that will help us in this pursuit of quality, safety and value. We want to inspire action through stories. We will be seeking ways to bring the people we serve into more conversations about their care and empower them to be an equal part of the care team.
What’s the bottom line?
Ultimately, through the pursuit of quality, we want to ensure that the experience of the people we serve is equal to our pursuit of the best possible outcomes for them. Still, we know that with the best of intentions, patients and residents may still experience harm. But we are committed to ensuring that we are transparent, accountable and learn from those events to improve. We see people at their most vulnerable and by pursing our five goals under this first strategic direction, in seven years — for every patient and every resident in a care home — we will be providing quality care that matters to them.
However, what “quality care” means is very different for different providers and different patient populations.
We have a chance to have a say in what outcomes the organization chooses to measure and track, in order to drive quality improvement work and resources. We want to know what matters most to your patients and your practice and relay that information to the organization as they set priorities moving forward.
You can also help us with our initial goals for this pillar:
• Develop meaningful metrics
• Create a Q/S/V online resource/portal
• Showcase the work of frontline staff
• Value-Based Healthcare Workshop
Interested in joining our discussions? Connect with us here >
These articles are a great introduction to Value Based Healthcare>
• Porter ME. What is Value in Health Care?
• Teisberg E, Wallace S. Creating a High Value Delivery System for Health Care
• Stowell C, Akerman C. Better Value in Health Care Requires Focusing on Outcomes: Harvard Business Review
• Porter ME. Measuring Health Outcomes: The Outcome Heirarchy
WELCOME FROM OUR PILLAR TEAM! Our physician leaders and advisors are representing medical staff in key areas of our strategic plan.
Dr. Adrienne MelckEndocrine and General Surgeon, Clinical Associate Professor in the Department of Surgery – 9 Years at SPH: “My elective practice focuses on the surgical treatment of thyroid, parathyroid and adrenal disease.” I am passionate about joint decision-making with my patients: I spend a great deal of time explaining things to them with pictures to ensure they fully understand their disease process and their options for treatment. I strive to provide compassionate care and I serve on a number of committees aiming to improve the quality of the surgical care that we provide. I love the multidisciplinary and collaborative nature of my work. This role is a conduit for clear communication between the medical staff and the leadership. I want to make sure I bring what matters to the medical staff to the forefront when high level decisions are being made about providing exceptional quality, safety and value. I also want to help promote a just culture of safety that encourages error reporting for the purpose of shared learning. I’m excited to create more forums to share quality improvement projects being done by frontline staff across the organization so we can all learn from what others are doing to improve care for our own patients. |
Dr. Ron CarereVice President, Medical Affairs Dr. Carere joined the Division of Cardiology at St. Paul’s in 1991. His continuing clinical practice focuses on Interventional Cardiology with a special interest in interventions in congenital heart disease and CCU medicine. He served as the Associate Head of the Division of Cardiology from 1998 to 2001. In 2001 he took on the role of Physician Director of the Heart Centre Program and in 2004 he also assumed responsibilities as the Regional Director of the Cardiac Program for the Vancouver Coastal Health Authority. He became Chair of the Providence Health Care Medical Advisory Committee from the fall of 2006 until May of 2010 when he took on the role of Acting Vice President of Medicine. |
Dr. Kristine ChapmanNeurologist at SPH, and Medical Director of the Neuromuscular Disease Program (VH). Associate Clinical Professor at UBC. I enjoy problem solving, and working with patients with neuromuscular disorders and their families to improve their health and quality of life. Finding better ways of delivering care is a passion as well. I am excited about working together with (and learning from) passionate and committed colleagues to improve how we deliver healthcare at Providence. Working to make our “Mission Forward” strategic plan a reality, and looking toward the new SPH is also exciting. |
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Dr. Trina MontemurroAnesthesiologist, St. Paul’s Hospital I am passionate about improving the overall experience for surgical patients at PHC. I am also passionate about improving team work and communication in the operating room. What I am most looking forward to in this role is inspiring and educating other physicians at Providence Health Care about Patient Safety and Quality. |
Dr. Janet SimonsMedical Biochemist & Internist, Pathology and Laboratory As a laboratory physician, a lot of my job is being a resource for other physicians and providing a reliable service that staff and patients can depend on. I want to ensure that the care we provide our patients represents the best possible use of our resources, including the energy and talents of our staff, and that all team members feel empowered to speak up and make suggestions about how we can improve.
In this role and work I am looking forward to helpng to develop a culture of reporting, learning, and constant improvement.
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Dr. Eileen WongFamily Medicine, Laboratory I am most passionate about making a difference in the lives of the frail elderly that I encounter in my work and hope to encourage and inspire others to improve patient care through quality improvement initiatives. This means choosing to improve the system for outcomes that are important to the patient not just the system. |
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Foundational Set of Standards introduced to Measure and Improve COVID-19 Health Globally
The International Consortium for Health Outcomes Measurement (iCHOM) has released an international COVID-19 Standard Set (C19-SS) of health outcomes. This was developed at a record setting pace, with our own Dr. Evan Kwong on the international working group panel! This an important step towards international harmony on collection of outcomes that matter to patients and Value Based Health Care. Get the information, standard set and reference guide here >
Doing Better by Our Patients: Chart Club Moves Quality Forward
Providence has been working in a collaborative with the Mayo Clinic on a multidisciplinary, multi-specialty mortality review process. It uses a standardized method for case review to “diagnose” process and system failures (versus provider failures) occurring during episodes of patient care. Over 15 months, a team of approximately 30 physician and nurse reviewers, social work and two patient partners, met at monthly meetings dubbed the “Chart Club.” They completed reviews of more than 100 cases and agreed on a total of 263 Opportunities for Improvement. Read more here >
BC’s Updated Definition of Health Care Quality: Dimensions and Matrix: Read here >
Learn, discuss & lead with colleagues
Watch for upcoming events here!
HOW-TO TOOLS
• PHC QI Challenge updates
• PHC Improvement Team
• Framework for QI Projects
• Courses & Skills
PART 1: Preparing for a quality improvement project in the emergency department
PART 2: Executing a quality improvement project in the emergency department
PART 3:Evaluating and sustaining a quality improvement project in the emergency department
• What is quality? This is a link to the newest version of BC’s Quality Health Matrix. The Quality Health Matrix “provides a shared definition of quality for BC’s health care system”. Learning about the health quality matrix is a first step in the quality and safety world.
• Events – This link has listed any upcoming webinars or conferences with a safey/quality focus.
• Quality Cafe – Lunch Series – Quality Cafe is a free one-hour lunch and learn series that takes place on the third Wednesday of every month at 1200 PST. Each Cafe features a new guest and topic related to improving quality of care.
LEARNING
RECOMMENDED READING
HOW-TO TOOLS
1) physician leaders interested in working more effectively with patient partners and their families to improve patient safety;
2) peer support programs for the psychological safety of healthcare providers
3) checklists for a whole variety of patient safety-related topics such as delirium, falls, central line infections, retained foreign objects and much, much more!
The IHI is recognized as a leader in the improvement of health and healthcare globally. At this link you’ll find a
• Patient Safety Essentials Toolkit
• a Leadership Guide to Patient Safety
• how-to guides for specific topics (e.g. adverse drug events, VAPs, SSIs) and
• the IHI Open School Patient Safety Curriculum which is packed with hundreds of modules, videos and downloadable tools and resources.
Botwinick L, Bisognano M, Haraden C 2006 Leadership Guide to Patient Safety: This IHI White Paper presents 8 steps for leaders to follow to achieve patient safety and high reliability in their organizations. It focuses on the acute care setting but the fundamental concepts can be applied to other healthcare settings.
RECOMMENDED READING
NEJM 2020 Gandhi TK et al: This recent NEJM article describes how a systems-focused approach is vital to improving patient safety and outlines the 4 interdependent elements required including patient engagement, the creation and sustainment of a culture of safety, the development of an optimal learning system and the effective management of change.
JAMA 2013 Zimlichman et al. Health Care-Associated Infections: A Meta-Analysis of Costs and Financial Impact on the US Healthcare System: This meta-analysis estimates the costs associated with the most significant and targetable health care-associated infections. CLABSIs were found to be the most expensive, followed by VAPs, SSIs, CDIs and CAUTIs.
2016 CIHI Report Summary Measuring Patient Harm in Canadian Hospitals: This provides a summary of a report developed jointly by the CPSI and CIHI measuring harm in Canadian Hospitals and outlining the 31 types of harm captured in the measure.
J Patient Saf 2015 Harrison R. Emotion and Coping in the Aftermath of Medical Error: A Cross-Country Exploration: This cross-sectional survey of 265 providers in teaching hospitals in the UK and USA describe the emotional response, coping strategies and perceptions of organizational support when a medical error has been made.
Fischhoff, B. (1975). Hindsight is not equal to foresight: The effect of outcome knowledge on judgment under uncertainty. Journal of Experimental Psychology: Human Perception and Performance, 1(3), 288–299. The classic paper. Knowledge of outcome distorts our understanding of an event and contributes to overconfidence in our ability to predict outcomes of future events. This is the primary flaw in retrospective analyses of patient safety events. Read >
Paget MA. The unity of mistakes: a phenomenological interpretation of medical work. Temple University Press. 1988. An existential view of medical work in which things go wrong as an intrinsic part of clinical work and probes the “complex sorrow” that can result. Read >
Weick KE. The collapse of sensemaking in organizations: the Mann Gulch disaster. Administrative Science Quarterly. 1993;38(4):628-652. 10.2307/2393339 Read >
Rochlin G. Safe operations as a social construct. Ergonomics. 1999;42(11):1549-1560. 1 One of the very first papers I read on safety. Based on empirical work on organizations that manage complex, technically hazardous operations. Safety understood as a dynamic, interactive and intersubjective action that is “not readily measured in terms of safety culture…and particularly vulnerable to disruption or distortion by well-meant but imperfectly informed interventions aimed at eliminating or reducing ‘human error’ that do not take into account the importance of the processes by which the construction of safe operation is created and maintained.” Read >
Dekker SWA. Why doctors are more dangerous than gun owners: a rejoinder to error counting. Human Factors. 2007;49(2):177-184. Read >
Woods DD, Dekker S, Cook R, Johannesen L, Sarter N. Behind human error, 2nd Ed. 2010. CRC Press:London. Essential reading. Goes behind ‘human error’ label.” Human error is cited over and over as a cause of incidents and accidents, and solutions are thought to lie in changing people or their role in the system. For example, we should reduce the human role with more automation, or regiment human behavior by stricter monitoring, rules or procedures. But in practice, things have proved not to be this simple. The label ‘human error’ is prejudicial and hides much more than it reveals about how a system functions or malfunctions.” Read >
Borys D, Else D, Leggett S. The fifth age of safety: the adaptive age. Journal of Health and Safety Research and Practice. 2009; 1(1): 19-27. Read >
Antonsen S. Safety culture assessment: a mission impossible. Journal of Contingencies and Crisis Management. 2009;17(4):242-254. Read>
Waring J. Constructing and re-constructing narratives of patient safety. Social Science and Medicine. 2009;69(12): 1722-1731. Read >
Hollnagel E. Coping with complexity: Past. present and future. Cognition, Technology & Work. 2012;14(3):199-205. Read >
Cook R, Rasmussen J. “Going solid”: a model of system dynamics and consequences for patient safety. Quality and Safety in Health Care. 2005;14:130-134. Read >
Mesman J. Resources of strength: an exnovation of hidden competences to preserve patient safety. In: A Socio-Cultural Perspective on Patient Safety. E. Rowley & J. Waring (eds.). 2012. Aldershot: Ashgate Publishing Ltd. Read >
Wears RL, Hunte GS. Seeing patient safety ‘Like a State’. Safety Science. 2014;67:50-57. Read >
Woods DD. Four concepts for resilience and the implications for the future of resilience engineering. Reliability Engineering and System Safety. 2015;141:5-9. Read>
Braithwaite J, Wears RL, Hollnagel E. Resilient health care: turning patient safety on its head. International Journal for Quality in Health Care. 2015;1-3. 10.1093/intqhc/mzv063 Read >
HOW-TO TOOLS
LEARNING
• 2021 Strategy for Health Care Delivery (3 days, January 2021) Attendees (~80) come from all over the world and represent a wide variety of disciplines, and within the clinical domain most are in senior leadership/decision making roles. View >
• 2021 Value-Based Health Care Delivery Intensive Seminar (5 days, January 2021) >
• 2021 Value measurement for Health Care (July 2021) Appears similar in structure to the Strategy for Health Care Delivery with more focus on measurement. View >
RECOMMENDED READING
• Teisberg E, Wallace S. Creating a High Value Delivery System for Health Care
• Stowell C, Akerman C. Better Value in Health Care Requires Focusing on Outcomes: Harvard Business Review
• Porter ME. Measuring Health Outcomes: The Outcome Heirarchy
Funding for physician leadership in this pillar is provided by the PHC Physicians and Surgeons Association (PASS) and SSC Facility Engagement.
