Bill 46: An Act Respecting the Care Provided By Health Care - - PDF document

Presentation to The Standing Committee on Justice Policy

Bill 46: An Act Respecting the Care Provided By Health Care Organizations

• Dr. Robert Bell,

President and CEO University Health Network

Karen Michell

Executive Director CAHO

Thursday, May 20, 2010

Check against delivery

Good afternoon and thank you for the opportunity to present today on the hearings for Bill 46 – The Excellent Care for All Act. My name is Bob Bell and I am the President and CEO of University Health Network and a member of the Executive for the Council of Academic Hospitals of Ontario (CAHO). With me today is Karen Michell, the Executive Director of CAHO. Overview of CAHO As some of you may know, the Council of Academic Hospitals of Ontario is the association of Ontario’s 25 academic hospitals and their research institutes. CAHO provides a focal point for strategic initiatives on behalf of our member hospitals. As research intensive hospitals, CAHO members are fully affiliated with a university medical or health sciences faculty. Our hospitals provide the most complex and urgent care to the sickest patients in Ontario, teach the next generation of health care providers and foster health care innovation derived from discovery research. These discoveries include the development of the first artificial kidney machine, identification of a critical gene that causes colon cancer, and the development of digital mammography and MRI screening for early detection of breast cancer in young women. Such discoveries have led to widespread improvements in ensuring healthier and longer lives for Ontarians. From research in the lab to real-life experience at the bedside, CAHO hospitals focus on improving the delivery of care and developing new and better ways to treat patients and

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cure disease. A 2008 national report attributed 77 percent of Canadian medical breakthroughs to Ontario research hospitals. Ensuring that all Ontarians continue to benefit from the discoveries of our CAHO hospitals, we need to make certain that Ontario remains a leader in harnessing this health research and innovation. CAHO will vigorously pursue the aspiration of making Ontario the premier health enterprise in the world. By supporting an environment that produces evidence-based world-leading health research and innovations, patients will continue to benefit from the discoveries of CAHO

• hospitals. This will in turn drive quality improvement for both patients as well as the

health care system. Outline of Presentation It is for this reason that we are pleased to see the Ontario Government move forward with legislation that sets a framework to enable evidence and best practice to drive quality improvement which will ultimately lead to a more accessible, safe and sustainable health care system for all Ontarians. With our time today, we would like to focus our remarks on three key areas of discussion.

• 1. Leading by Example: Most of our research hospitals already have in place many
• f the initiatives the Government is proposing in this legislation. The Government

needs to leverage the leadership and experience that already exists in the health care system to achieve their objectives of this legislation.

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• 2. One Size Does Not Fit All: As the Government moves forward with the

development of regulations and guidelines prescribed in the legislation, we need recognize the fact that all hospitals in Ontario are not the same and regulations and guidelines need to be developed with that in mind.

• 3. Getting it Right Through Collaboration. As many of the members of the

legislature pointed out during the debate in the house on this Bill, the devil is in the details. We are encouraged that the government intends to work collaboratively with all partners to ensure that the spirit of the legislation is honoured, while creation a practice process for implementation. Leading by Example Research hospitals are already doing much of what the Government is trying to achieve with this legislation. CAHO hospitals have been at the forefront of efforts to drive quality improvement in health care for some time. For instance, at my own hospital here in Toronto, we have had a Quality of Care Committee (QCC) established for quite some time. This committee is tasked with ensuring quality patient care and a safe environment for patients, visitors and staff. The multi-disciplinary committee meets a minimum of ten times a year and provides quarterly updates to the Board. And I know we are not alone. Many CAHO hospitals have a similar model. In addition, UHN has a Quality Committee of the Board because the Public Hospitals Act deems the volunteer board accountable for the care delivered in the hospital. The

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purpose of this committee is to review the quality of patient care and service delivery at UHN and make recommendation so the Board as required by monitoring key indicators

• f organization performance. This committee meets at least nine times a year and

provides an annual report to the Board that summarizes relevant quality of care and service issues that arise. This Committee also employs an annual performance improvement plan with measureable goals. So, our hospital, as with many others in the province, already have executive compensation tied to performance objectives. Many research hospitals also have very extensive patient relations processes. The Ottawa Hospital for example has a Patient Advocacy and Clinical Risk Management

• Program. This program is designed to address the concerns that patients and their

families have about the care they receive. But it doesn't stop there. Ottawa's program systematically uses these interactions with patients to learn how to make hospital care better for all patients. And this is by no means an exhaustive list. My peers within CAHO have also implemented many similar initiatives within their own hospitals. We undertook these initiatives not because we were required to do so; rather, as research hospitals it is engrained within our culture to strive for continuous improvement. We do this because it provides better care. As research hospitals, we use evidence and best practice to drive quality improvement which will ultimately lead to a more accessible, safe and sustainable health care system for all.

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One Size Does Not Fit All It is worth noting that Ontario’s research hospitals are world-class. We compete on a global scale for research partnerships, top clinical and research talent, and investments. We have a unique role in our health care system. The mandate of a research hospital includes providing the most complex and resource intensive patient care in the health care system. This includes 100 percent of organ transplants and 83 percent of neurosurgeries, to name but a very few examples. In addition, 80 percent of health research in Ontario takes place in academic health sciences centres; the balance occurs at universities.i As the fourth largest biomedical research centre in North America, Ontario employs 10,000 researchers in a variety of disciplines across its research hospitals. This is an outstanding place to be when our economic future is tied to knowledge and innovation. CAHO hospitals serve all Ontarians. Regardless of what community a patient lives in and what local health integration network the research hospital is located within, we serve patients from all across the province. As the Government develops regulations and guidelines as prescribed in this legislation, we caution the Government against “one size fits all” changes that don’t make sense to all hospitals. For instance, our colleagues who operate rural hospitals have very different issues and challenges than we have at our research hospitals. Research hospitals should have different metrics for performance than community hospitals, reflecting the different roles we play in the system. For example, our

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executives should be held accountable for outcomes relating to specialized care, teaching and research. But this is not true for all hospitals. We applaud the Government’s intent of greater transparency and accountability. Most Boards of CAHO hospitals have already set performance targets for their institutions and their executives. We would encourage the Government to ensure that its efforts are complementary to these existing best practices. We believe that you can’t improve what you don’t measure. We also believe that the baseline for measurement needs to realistic and applicable. By taking a balanced approach to measurement, improvements across the system are achievable. As the Government moves forward with regulations and guidelines for increased transparency and accountability, we would recommend they work diligently to ensure that hospitals, and ultimately all health care partners, measure what matters and ultimately what will drive continuous improvements. No one benefits, especially patients, from unnecessary red tape that creates process for the sake of process. Getting it Right Through Collaboration As I mentioned before, we are supportive of this legislation and the potential it has to use evidence and best practice to drive quality improvement. And I think that all members of the Committee would agree that the intention of this legislation is a positive step forward. However, the legislation sets the framework from which these changes will occur. The details – the reality of what this legislation will do and how it will be done – will be prescribed in the regulations and guidelines that follow.

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We are encouraged that the Minister has stated her intent to be collaborative and consultative with CAHO hospitals and others as the Ministry develops the regulations and guidelines to support this legislation. It is important that the Minister and the Ministry draw on the expertise that exists in CAHO hospitals as well as others in the health care system to ensure that the details enable the success of the intent of the legislation. We reiterate our offer to lend our expertise and guidance where regulations, policies and guidelines are developed. Through CAHO, we can ensure both the breadth and depth

• f engagement the Government is seeking and to learn from those who have already

implemented many of these changes the Government is pursuing. Closing The Minister developed this legislation on four principles:

• 1. That care must be organized around the patient to support his or her health;
• 2. That continuous improvement is a continuous goal;
• 3. That payment, policy and planning must support both quality and the efficient

use of resources; and

• 4. Quality care must be supported by the very best evidence and standards of

care. We applaud the spirit of this legislation and welcome the opportunity work collaboratively with the Government and all members of the Legislature to ensure that the intent of this

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legislation is respected and works to provide the world-class health care all Ontarians need and deserve. CAHO hospitals are privileged with a unique leadership role in our health care system based on the fundamentals of research and innovation to drive quality improvement for both patients as well as the health care system. We have an excellent health care system in Ontario. We want to do our part to make sure that future generations have access to an even better health care system. I would like to thank you for your time today and now Karen and I would be happy to answer any questions you may have. Thank you.

i Association of Canadian Academic Healthcare Organizations (ACAHO). Research Funding Flow Survey.

2005.

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