Download ACCREDITATION CANADA ENVIRONMENTAL SCAN SUMMARY

ACCREDITATION CANADA ENVIRONMENTAL SCAN SUMMARY MAY-JULY 2008
RÉSUMÉ DE L'ANALYSE DU MILIEU DU AGRÉMENT CANADA MAI-JUILLET 2008
Category
Accountability
and
Performance
Issue
AB
 Alberta has launched a searchable online database of 550 licensed
supportive living facilities and seniors’ lodges in the province.
People can review a facility’s license status, view inspection results,
and find out about any complaints about accommodations.
Information on supportive living facilities is available at
www.seniors.gov.ab.ca/ContinuingCare, by clicking on the
Supportive Living Public Reporting Information link. Health Edition
2008/07/18
Health Care
Restructuring/
Systems Issues
AB
 Alberta Health and Wellness Minister Ron Liepert released a
progress report on items that were tagged as immediate initiatives
or three-month action items. Most of the 27 items are still in
progress, and some of the activities underway include development
of an Alberta Patient Navigation System to create “the first-ever”
approach to guiding patients through the entire health system.
 As of the end of June, more than 500 health providers were
scheduled to have completed education sessions on this new
approach put on by McMaster University. Teams have also been set
up to monitor compliance with infection prevention and control
standards, as well as continuing care service standards. A policy
framework for primary health care is in development, and an
implementation plan will be developed this September based on
consultations with stakeholders. The timeline has been revised for
setting up a virtual campus and rural mentoring program for
Strategic Directions/
Implications
Although we do not have
specific standards for
community living at this time,
organizations providing such
services could become
accredited using the Home
Care or Community Health
Services standards.
For information.
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medical students which would allow third-year students to
complete eight-month rotations in rural areas.
 Health Career Centres are opening in Edmonton and Calgary to
help young Albertans and internationally-educated health
professionals choose a health care career in the province.
 The status report can be accessed at
www.health.alberta.ca/key/health-action-plan-2008.html . The next
report will be released by September 15. Health Edition 2008/07/11; Health
Action Plan status report – Alberta Health and Wellness
Health Policy
Issues
AB
Some health organizations in Alberta are looking at LEAN
principles. Follow this link for a description of LEAN from the
perspective of Alberta Finance:
http://www.albertacanada.com/productivity/lean/index.html
Judith Dyck
Health Care
Restructuring/
Systems Issues
AB
 Alberta is scrapping its nine regional health authorities and creating
a new Alberta Health Services Board (AHSB) responsible for health
service delivery for the entire province. Voluntary Community
Health Councils will be appointed by the AHSB to provide input on
local health issues.
 The AHSB will report directly to Minister of Health and Wellness
Ron Liepert whose ministry will continue to be responsible for
setting, monitoring and enforcing provincial health policy,
standards and programs, as well as for managing health capital
planning, procurement and outcome measures. “Moving to one
provincial governance board will ensure a more streamlined system
for patients and health professionals across the province,” Mr.
Liepert said in a news release.
 The AHSB will also take over the functions of the Alberta Mental
The principles of LEAN are
aligned with the principles of
quality improvement that are
threaded throughout the
Accreditation Canada’s
standards.
With the major restructuring in
Alberta, it may be necessary to
reshape how surveys are
organized, scheduled, and
conducted. Accreditation
Canada will work
collaboratively with the key
Alberta stakeholders to identify
solutions and next steps.
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Patient Safety
BC
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Health Board, Alberta Cancer Board and Alberta Alcohol and Drug
Abuse Commission. Health Edition 2008/05/16
Twelve per cent of patients who rush to the emergency room at
Vancouver General Hospital are there because of adverse effects
from medications, according to study published in the Canadian
Medical Association Journal. The 11 international authors of the
study said patients with medication-related complaints are more
likely to be admitted to hospital after they've been seen in the ER
and occupy beds far longer than others, a result the authors
described as "striking."
The study estimates that 70 per cent of such visits are preventable
through better prescribing, dispensing and monitoring of patients.
"We've proven in this study that we've got a problem in the health
care system with patients who experience bad effects from
medications, and we have to figure out how to reduce those
problems," said lead investigator Dr. Peter Zed, who was working at
the hospital during the study but is now at the Queen Elizabeth
Health Sciences Centre in Halifax.
"The solutions will involve better communication among doctors,
pharmacists and patients," Zed said in an interview. "Simply
handing out a pamphlet at the pharmacy that lists all the potential
side effects doesn't work. Patients don't read them or they don't
understand the information."
Problems stemmed from a variety of issues, including patients being
prescribed the wrong drugs, given wrong dosages, allergic
reactions, interactions between drugs and patients not following
instructions for how or when to take their medications.
The province plans to establish a patient safety and quality council
The ROPs include the
requirement for established
processes for reporting adverse
events.
New Medication Management
standards have been
incorporated into Qmentum.
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Health Policy
Issues
BC
to reduce adverse events, promote transparency and identify best
practices to improve patient care. Times Colonist (Victoria) 2008/06/03
 Twelve pieces of health legislation passed during the spring session
of British Columbia’s provincial legislature. This is significant not
only in the number of bills passed but the underlining
direction/focus of legislation as it pertains to changing how the
existing system operates. Other provincial governments are likely to
follow suit.
 Legislation covered cost recovery (re class action suites), MSC
transparency, Medicare Protection Act, public health, Health
Professions Act, e-Health, Bill 29, labour mobility (TILMA), patient
care quality review boards, ambulance fees, MHA “not in my
backyard,” and smoking.
 Much of the impetus behind the legislation is from the provincial
consultation on the “Conversation on Health.” Issues being
addressed include 1) transparency for the public (patient care
quality review boards MSC transparency; 2) ability to overrule
professional bodies, i.e the Colleges of Physicians and Surgeons,
nursing, etc. (health professions act) 3) breaking down barriers to
provide more flexibility in the system ( Bill 29, ability to outsource,
Health Professions Act, Labour mobility TILMA, e-health and 4)
sustainability, Medicare protection act).
With the reshaping of how
health services are provided in
different provinces, it is
important that Accreditation
Canada continue to work with
the provinces and their
ministries to ensure the
accreditation program remains
relevant and responsive,
respecting provincial/territorial
differences yet ensuring the
integrity of the program..
Murray Ramsden
Health Trends
CDA
 Health issues are a growing concern for employers, a survey by
Mercer Human Resource Consulting and the Canadian Alliance on
Mental Illness and Mental Health has found. Fully 80 per cent of
452 people interviewed, mostly human resource professionals,
reported that mental health issues have increased in importance
The accreditation program
includes standards for mental
health. The standards also
emphasize quality of worklife,
recognizing its relevance to
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Accountability
and
Performance
CDA
compared to three to five years ago. However, only 13 per cent said
senior executives in their companies have a strong awareness of the
impact of mental health issues. It has been determined that mental
illness is estimated to result in 35 million workdays lost every year
in Canada. Health Edition 2008/07/18
According to Health Data 2008, an OECD report released in June:
 Canada is among eight countries that spent 10 per cent or more of
GDP on health care in 2006.
 Canada has higher per capita expenditures for health care ($3,678 as
measured on a U.S. dollar purchasing power parity basis) than the
OECD average of $2,824. This was also a higher outlay than any
other G7 country.
 Canada has fewer physicians per capita than in most other OECD
countries. In 2006, Canada had 2.1 physicians per 1,000 population,
well below the OCED average of 3.1. The supply of registered
nurses was also lower (8.8 versus 9.7 per 1,000 population).
 The number of acute care hospital beds per 1,000 population in
Canada was substantially lower than the OECD average – 2.8 versus
3.9 (as was the number of long-term care beds in 2005) and the
supply of MRI machines and CT scanners in Canada was also below
the international norm.
 The proportion of public health expenditures spent on home care
(3.2 per cent) was about middle of the pack.
Life expectancy in Canada is a year-and-a-half higher than the
OECD average, but infant mortality is somewhat higher. Obesity
rates are also higher than most other OECD countries.
 The $532 U.S. in Canadian household out-of-pocket health spending
in 2006 was above the OECD average. Also, 67 per cent of the
quality of health care.
For information.
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Canadian population was covered by some sort of private health
insurance in that year – only France and the Netherlands had a
higher proportion among countries where this information was
collected. Even the proportion of Americans with private health
insurance (65.2 per cent) was lower. The summary report can be
found at: http://www.oecd.org/dataoecd/46/33/38979719.pdf.
(Access to the database is available by subscription only.) Health
Edition 2008/07/04
Accountability
and
Performance
CDA
Highlights from the Conference Board of Canada’s annual report card
include:
 Increasing levels of mortality due to diabetes should be raising
alarm bells, not only among Canadian policy makers but also among
the public. Canada eclipses even the U.S. in deaths due to diabetes
despite that country’s higher obesity rates.
 Mortality rates on a number of diseases have improved in Canada –
as they have in other countries – but progress has not been made
everywhere. Aside from diabetes, it said mortality rates from mental
illness have steadily increased.
 Canada received a “B” in the health category, ranking ninth out of
16 countries. This has been the same grade the Board has awarded
since the 1970s but it warns it might slip in future reports. Japan and
Switzerland are “A” performers in health as far as the Conference
Board is concerned, and it said Canada has a lot to learn from them.
 Most of top-performing countries have achieved better health
outcomes through actions on the broader determinants of health
such as environmental stewardship and health promotion programs
focusing on changes in lifestyle, including smoking cessation,
increased activity, healthier diets, and safer driving habits. Leading
countries also focus on other determinants of health—such as
For information.
7
education, early childhood development, income, and social
status—to improve health outcomes.
 The Board is concerned that Canada is not ready for the growing
burden of chronic disease. It encourages governments to adopt a
new business model of health care that encompasses both
preventing and managing chronic disease. Targets set by
governments in the Public Health Agency of Canada’s Integrated
Pan-Canadian Healthy Living Strategy are the building blocks of a
prevention-oriented strategy. Developing a report card that assesses
Canada’s progress on its health care goals would be another
important step.
 The summary report on health, part of How Canada Performs: A
Report Card on Canada, can be found at
http://sso.conferenceboard.ca/HCP/overview/default.aspx. Health
Edition 2008/07/04
 The Toronto Star takes issue with the Conference Board’s approach
to assessing Canada’s quality of life which the Star says puts an
inordinate emphasis on innovation and productivity. This leaves
other important things out of the equation, the Star says. “It is true,
for example, that health care wait times are longer in Canada than in
the U.S., where an MRI can be had on demand. Is the difference just
a sign that the Americans are more innovative or technologically
adept than we are, or is it a reflection of the fact that only those with
the money or insurance can get an immediate MRI in the U.S.? If
you could measure the value to society of universal health care, then
the points we would get for our social innovation would offset to a
degree the points we lose for having longer wait times.” Toronto Star
2008/07/02
Health Trends
CDA
 There have been some encouraging developments to home care in
The aging population will have
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Accountability
and
Performance
CDA
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the past several years, the Canadian Home Care Association says in
an update of its 2003 report, Portraits of Home Care in Canada.
Over the last decade, there has been an over 50 per cent increase in
the number of people receiving home care. The report provides a
detailed analysis of home care in each jurisdiction, but it notes that it
is difficult to make comparisons between them “because of the
absence of data definitions and the variation of data collection
methods and reporting across Canada.”
Still, it says governments are recognizing the importance of home
care in service delivery. Initiatives taken include linkages with
primary care, new approaches to chronic disease management, and
offering new and enhanced programs for populations with specific
care needs.
There is also more use of information and medical technology for inhome care which the association says will have an impact on human
resource requirements for the sector, training needs, as well as “the
overall approach to the delivery of home care in the very near
future.”
The number one challenge for the sector is health human resources,
and it says the sector will be “disproportionately impacted” by the
requirements of an aging population.
Details on how to obtain the report can be found at
www.cdnhomecare.ca . Health Edition 2008/07/04
A report by the House of Commons Standing Committee on
Health concluded Canadians deserve better accountability for how
governments are spending the $41 billion invested in the 10-Year
Plan to Strengthen Health Care, an accord reached by First Ministers
at their health summit in September 2004.
The Committee held four hearings and its report chronicles the
significant implications for
Canadian home care programs.
Accreditation Canada currently
has standards for home care
that may be enhanced as the
demand for home care
increases.
For information.
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Health Trends
CDA
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largely critical comments it received from various groups about
what has been accomplished on the 10 components of the plan.
Among other things, these groups said there has been uneven
progress on the development of multidisciplinary primary care
teams, there is no clear picture on the state of home care, and there
has been a relative lack of progress on a pan-Canadian National
Pharmaceuticals Strategy.
Despite repeated warnings about a looming health human resource
shortage of crisis proportions, the nationwide collaboration
envisioned in the plan has not yet resulted in coordinated planning.
Even on the wait-time focus of the plan, described by First Ministers
as a national priority, efforts received a mixed grade.
The failure of federal and provincial-territorial governments to come
to terms on a set of comparable indicators to measure progress was a
focus of the Committee’s report plus the fact that they have not lived
up to their promise to be accountable. Both levels of government
have failed to honour their commitment to report on progress being
made.
The report can be found at:
http://cmte.parl.gc.ca/cmte/committeehome.aspx?selectedelementid
=e1_&lang=e&parlsession=392. Health Edition 2008/07/20
Home care programs are not getting enough attention in provincial
e-health initiatives, the Canadian Home Care Association says in a
report sponsored by Canada Health Infoway.
The report is based on cross-country consultations with hundreds of
home care leaders.
Their overriding message is that hospitals are on the receiving end
of most of the e-health or Information Technology (IT) investment
Accreditation Canada has
developed supplementary
criteria for telehealth. The
supplementary criteria will be
available in Qmentum in 2009.
Accreditation Canada has
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and this is going to have to change if governments are to make good
on their efforts to shift the emphasis from acute to community-based
care.
 “Most home care programs have not been given priority in
provincial and/or regional IT plans, nor do they have dedicated
budgets for technology,” the report says. As a result, they are left
with fragmented approaches often done on a pilot project basis.
 Most governments have launched programs to promote “aging at
home” to lessen seniors’ need for institutional care and even their
reliance on hospital ERs. This could be substantially aided by
information and communications technology for such things as
remote monitoring of their conditions, the report says. This
technology also has the potential to improve access to care for the
almost one-in-four Canadians who live in rural, remote and
northern communities, it claims.
 The report, containing nine recommendations for further activity
and investment in this area, is available at www.cdnhomecare.ca.
positive relationships with both
the Canadian Home Care
Association and Canada Health
Infoway.
Health Edition 2008/07/13.
Accountability
and
Performance
CDA
 According a report from the Health Council of Canada, Canadian
taxpayers have a right to expect better value and greater
accountability from the health care system they pay for, and they
clearly have not got full measure out of the $36 billion First
Ministers invested in the 2003 health accord. At best, the Council
says the glass is half full.
 While the report chronicles a number of achievements which have
been made, its overall message is that the health reform agenda
lacks cohesion, as does the common front First Ministers talked
about to tackle the problems they share with their respective health
systems. “To date, Canadian health care reform has largely created a
For the third year in a row, the
Health Council of Canada has
said that “accreditation should
be a mandatory condition of
public funding and that
institutions should make their
accreditation reports public.
This important measure would
help health care institutions
become more accountable to the
public they serve.”
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patchwork of pilot projects, not system-wide change,” the Council
says.
The $800 million federal Primary Health Care Transition Fund, set
up in 2000, has been mostly used to implement “small initiatives
rather than invest in long-term, sustainable change,” the report
comments.
With home care, governments have provided two weeks of postacute care, as they said they would, but “progress in ensuring access
to broad, equitable home care services has been slow and
piecemeal.” As a result, a number of Canadians must pay out of
pocket for the services they need.
Despite imminent shortages with an aging workforce, “the
nationwide collaboration envisioned in the 2003 accord has not yet
resulted in coordinated planning.” Provinces are doing their own
thing and outbidding each other for the health professionals they
need.
Governments have fallen short on their promises to be accountable
for the vast amounts of taxpayers’ money they are spending on
health reforms. “Too much of current reporting takes place in
isolation, and most governments do not use or report the
standardized data to which they committed,” the report says.
In all, the Council found deficiencies in nine areas “where action has
been slower, less comprehensive, and less collaborative than First
Ministers originally envisioned in their 2003 accord.” Health Edition
2008/06/06
Patient Safety
CDA
 According to a study published in the May issue of the journal
Infection Control and Hospital Epidemiology, the re-use of single-use
medical devices is still common in Canada. The study found 28 per
cent of 398 hospitals are following this practice. This is down only
The accreditation program
includes standards for the
Reprocessing and Sterilization
of Reusable Medical Devices.
12
Accreditation
Canada
CDA
slightly from 31 per cent in 1986. Furthermore, 85 of hospitals who
re-use these devices reprocess them in-house. Only 15 per cent send
them to regulated U.S. companies for reprocessing under the
watchful eye of the FDA. Health Canada does not regulate
reprocessing. Canadian Press 2008/05/25
 Canadian hospitals will have to audit hand-hygiene if they want to
receive accreditation. New rules from Accreditation Canada will
come into effect next January. Hospitals will also need to have a
plan to maintain or improve hand-washing compliance. Globe and Mail
The standards make specific
reference to the issue of reusing single-use medical
devices.
The new ROP on auditing hand
hygiene will be applied to
accreditation surveys beginning
in 2009.
2008/05/23
Patient Safety
CDA
 Almost one-in-five hospital nurses admit making medication errors
occasionally or frequently, Statistics Canada said in a report based
on the 2005 National Survey of the Work and Health of Nurses.
Factors related to medication error included regularly working
overtime, role overload, perceived staffing shortages or inadequate
resources, poor working relations with physicians, lack of support
from co-workers, and low job security. Medication error was
significantly related to overtime. Of those nurses who worked
overtime, 22 per cent reported medication errors versus 14 per of
those who did not work overtime. Health Edition 2008/05/16
Accountability
and
Performance
CDA
 The Public Health Agency of Canada has been found to come up
short in being able to protect Canadians from the threat of infectious
disease. In her annual report, Auditor General Sheila Fraser devoted
an entire chapter to surveillance of infectious diseases and whether
the government had addressed serious concerns raised in past
Five ROPs address medication
use. Two new ROPs that will
apply to surveys starting in
2009 are on heparin safety and
narcotic safety. There are two
ROPs on adverse events,
sentinel events, and near
misses—establishing a
reporting system and
implementing policies and
procedures. Many of the
contributing factors cited in this
report are identified within our
existing standards.
Accreditation Canada plays a
key role in fostering quality
improvement. Through our
Patient Safety Performance
Measures that are integrated
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reports.
While PHAC has laid the groundwork for the sharing of essential
information in the event of a public health emergency, Ms. Fraser
said procedures for “notifying other parties, and protocols affecting
the collection, use, and disclosure of personal information” still have
to be sorted out. “Consequently, faced with a public health threat
that could affect other countries, the Agency may be unable to notify
the World Health Organization within the times specified in the
revised International Health Regulations and to keep it informed of
subsequent events,” she said.
The situation is worse for routine surveillance information. PHAC
has only just signed a data-sharing agreement with Ontario, but not
with any of the other provinces and territories. “This limits its ability
to provide Canadians with a complete and consistent national
picture of infectious diseases as a basis for public health actions,”
Ms. Fraser said, although she acknowledged the fact that PHAC
depends on the goodwill of its provincial-territorial partners to
collect the information it needs. Health Minister Tony Clement said
he will use the Auditor General’s report as a “springboard” for
getting the different jurisdictions to sign the data-sharing
agreements he has been after them to do for the past two years.
PHAC itself said it has been working on the issue for three years,
and has participated in a number of forums to address issues of
surveillance information. It also said it is in the process of
developing a framework for the management of privacy issues
which it expects to complete in March 2009.
In a five-year action plan responding to Ms. Fraser’s audit, the
agency said it will deal with all her principal points by the end of
next year.
into Qmentum, we are
exploring the most practical,
effective approach for
organizations to collect and
share information on
measuring and preventing
infection.
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 She also noted that PHAC and the Canadian Food Inspection
Agency have not come up with a list of the highest priority animal
diseases which could affect Canadians. As she pointed out, this is
important given that 65 to 80 per cent of new human diseases come
from animals.
 The Auditor General’s report can be found at www.oag-bvg.gc.ca.
Health Edition 2008/05/09
 Federal Health Minister Tony Clement says he will use this week's
Health Trends
CDA
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Auditor General's Report "as a springboard" to urge provinces to
share more health-related information to make sure Canada is ready
for the next pandemic. The Leader-Post (Regina) 2008/05/08
The federal government should set up a national system of
standards for medical testing laboratories as a way to prevent errors
that could lead to faulty diagnoses, the Canadian Association of
Pathologists says.
At its annual conference, the group unveiled a five-point action plan
for "an appropriately resourced national system to promote
excellence in the laboratory medicine in Canada."
The call for new standards comes amid sharp public scrutiny over
allegations of botched tests, inadequate professional controls and
incompetence in several Canadian provinces.
The organization is urging the "creation of a national body, separate
from government, to accredit all medical laboratories in Canada and
ensure they meet quality and critical mass standards."
The proposal also urges mandatory certification for tests performed
by medical labs and an external validation system, in which test
results from one lab are verified by a separate and independent lab.
"We are unique in that we lack a national quality-assurance program
to link laboratories, provide support and administer national
Our new lab standards are
relevant to this issue.
Accreditation Canada is
ensuring that key stakeholders
are aware of this component of
our program, and their
contribution to this area of
concern.
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Patient Safety
CDA
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standards."
The group also calls for the use of a national diagnostic checklist that
would serve as a quality assurance system for labs.
Antimicrobial wipes commonly used in hospitals to clean surfaces
like bed railings may in fact spread bacteria, such as MRSA, if used
incorrectly, according to a new study from researchers at Cardiff
University in Wales. The study, found that many wipes clean but
don't kill bacteria from surfaces, meaning that if the wipe is re-used,
bacteria can be transferred from one surface to another.
This could lead to the spread of bacteria such as antibiotic-resistant
Staphylococcus aureus, or MRSA. This type of staph bacteria is
spread via skin-to-skin contact or contact with a contaminated
surface. MRSA can lead to life-threatening infections of the
bloodstream, bones or lungs if left untreated.
As a result of their findings, the researchers, led by microbiologist
Dr. Jean-Yves Maillard, recommend a one wipe, one application per
surface policy for cleaning surfaces in health-care facilities.
"On the whole, wipes can be effective in removing, killing and
preventing the transfer of pathogens such as MRSA but only if used
in the right way," Dr. Gareth Williams, a microbiologist at Cardiff's
Welsh School of Pharmacy and one of the study's authors, said in a
statement.
"We found that the most effective way to prevent the risk of MRSA
spread in hospital wards is to ensure the wipe is used only once on
one surface."
The researchers observed hospital workers as they used wipes to
disinfect surfaces that both workers and patients would come in
contact with. They found that one wipe was being used on the same
Infection Prevention and
Control standards are part of
Qmentum.
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Health Policy
Issues
NB
surface several times and then used on other surfaces before being
thrown away. CTV.ca News 2008/06/03
 New Brunswick has launched a task force to develop a new mental
health strategy. It will start public consultations in the fall, and a
mental health forum will be held in October. The final report of the
task force is due next February. According to a provincial ranking,
New Brunswick had the second-highest rate of spending on mental
health among provinces in 2003-04 at six per cent. Health Edition
2008/05/23
Accountability
and
Performance
ON
Accountability
and
Performance
ON
 Ontario’s ombudsman Andre Marin will conduct a full
investigation of the province’s monitoring of long term care
facilities, as well as its effectiveness in ensuring nursing homes meet
government standards, although he does not have the authority to
investigate nursing homes themselves. His office has been reviewing
more than 100 complaints about long term care since early spring.
This includes 50 complaints in the last couple of weeks following
media reports that a large number of nursing homes are not meeting
provincial standards. Mr. Marin says he will be taking a look at
these 400-some standards and ascertain whether they are “piddly
bureaucratic rules” that just take time away from patient care. The
investigation is expected to take six months. Health Edition 2008/07/18
 Over 60 per cent of Ontario’s long term care homes have been cited
for violating provincial basic standards of care, Canadian Press
reports. Results of inspection reports have been posted online and
three-quarters of the 616 nursing homes in the province have been
found to be not in compliance with at least some of the 400
standards. However, there are complaints that some of these things
The accreditation program
includes standards for mental
health.
A new ROP on assessing and
monitoring clients for risk of
suicide will apply to surveys
starting in 2009.
Accreditation Canada’s Ontario
team maintains ongoing
dialogue with the Ontario
Ministry of Health and LongTerm Care regarding the
accreditation of long term care
facilities and the provincial
compliance program. Meetings
with Ministry staff will
continue in the fall.
The accreditation program
includes standards for long
term care yet only
approximately 50 per cent of
Ontario long term care facilities
participate in our program.
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are unrealistic and unrelated to quality of care. “When you are
living in a quasi-police state, you’re just focusing on keeping your
nose clean and documenting rather than doing what’s important,”
Donna Rubin, CEO of the Ontario Association of Non-Profit
Homes and Services for Seniors, told CP. Health Edition 2008/07/04
Accountability
and
Performance
ON
 Better communication is needed in Ontario’s health system, a study
by the Ontario Hospital Association’s Change Foundation has
found. The organization drew from a number of sources for its
study including 10 focus groups with patients and caregivers.
 Common problems identified were patients knowing who to call,
what to ask, and how to move from provider to provider. “Many
patients and caregivers expressed confusion and frustration, asking:
‘Who’s in charge? Is anybody listening? And, what are the next
steps in my treatment or care?’” Change Foundation CEO Cathy
Fooks said in a news release. “Too often, they found that health care
providers weren’t communicating with each other – or with patients
and their families. And they had trouble trying to coordinate the
health services they need, especially when moving from hospital to
the community.” She commented that even when care or
coordination was excellent, it sometimes seemed to patients and
caregivers that it was despite the system – not because of it.
Accreditation Canada’s Ontario
team maintains ongoing
dialogue with the Ontario
Ministry of Health and LongTerm Care regarding
accreditation of long term care
homes and the provincial
compliance program. Meetings
with Ministry staff will
continue in the fall.
Accreditation Canada
recognizes the impact
communication has on patient
safety. There are five ROPs that
address communication issues,
one of which focuses on
information transfer. Many
other standards also focus on
effective communication, both
between the health care team
and patient/client, as well as
among the health care team
members.
18
 The report makes a number of recommendations including
accelerating the implementation of electronic health records so
providers can better coordinate patient information, and access to a
professional “care coordinator” or system navigator responsible for
coordinating care across settings and providers.
 The report is available at www.changefoundation.ca. Health Edition
2008/07/13
Information
Management
PE
Health Policy
Issues
QC
 A new Clinical Information System is now in place at all hospitals in
Prince Edward Island. I t is in operation at Registration, Lab and
Pharmacy departments and is also being used by nursing staff to
record patient vital signs. More features, including physician orders,
nursing documentation, and functionality for Surgery and
Emergency departments will be introduced later this year and early
next year. Health Edition 2008/05/16
 New Quebec Health Minister Yves Bolduc is anxious to put “lean”
thinking to work for improving the quality and efficiency of health
care in the province. The concept, already well entrenched in health
care, is based on the Toyota Production System for building cars.
What works for the assembly line also has value for the smooth flow
of patients through the health system. It is based on the principle of
improving work processes based on best evidence and employee
input – a cycle of continuous quality improvement where, in the
health care context, the “patient comes first.”
 Reduced waste and costs, and improved quality, are among the
results obtained in some applications of lean management thinking
at hospitals throughout the U.S. A number of health regions in
Canada – particularly in Saskatchewan – have become adherents to
this management approach.
Information management
standards are woven into
Qmentum.
The principles of LEAN are
aligned with the principles of
quality improvement that are
threaded throughout the
Accreditation Canada’s
standards.
Of interest, Dr. Bolduc is an
Accreditation Canada surveyor
(inactive due to his current role
with the Quebec government).
19
 Previously, Dr. Bolduc was in charge of health operations in the
Questions
relatives aux
politiques en
matière de
santé publique
QC
Val-d’Or region in Quebec and was in the midst of a pilot project to
use the lean management approach at the local hospital. Surgical
volume had already been enhanced while costs had been cut 5 to 10
per cent. Patients’ wait time in hospital had also been substantially
reduced by having them come one hour before their scheduled
surgery instead of three. They also walked on their own to the
operating room instead of being transported on a gurney – saving
staff time. Health Edition 2008/07/11
 Le nouveau ministre de la Santé du Québec, Yves Bolduc, est
impatient de mettre en œuvre une philosophie de « l’allègement »
dans le but d’améliorer la qualité et l’efficacité des soins de santé au
sein de la province. Le concept d’allègement, déjà bien ancré dans
les soins de santé, est axé sur le système de production de voitures
chez Toyota. Les facteurs qui permettent notamment à la ligne
d’assemblage de bien fonctionner favorisent également le bon
cheminement des patients dans le système de santé. Le concept de
l’allègement s’inspire donc du principe d’amélioration des processus
de travail fondé sur les meilleures preuves actuelles et l’avis des
employés; il devient, dans le milieu des soins de santé, un cycle
d’amélioration continue de la qualité où « le patient occupe la
première place ».
 La réduction du gaspillage et des coûts, ainsi que l’amélioration de
la qualité, se trouvent parmi les résultats obtenus suite à certaines
applications de la philosophie de l’allègement au sein d’hôpitaux
américains. Un certain nombre d’organismes de santé régionaux au
Canada, en particulier en Saskatchewan, ont adopté cette
philosophie de gestion.
Questions relatives aux
politiques en matière de santé
publique
20
 Le Dr Bolduc était responsable auparavant des opérations en matière
Patient Safety
QC
Sécurité des
patients
QC
de santé dans la région de Val-d’Or au Québec. Il a mis à l’essai dans
un hôpital local un projet axé sur la philosophie de l’allègement. Le
volume de chirurgies a augmenté, tandis que les coûts étaient
réduits de 5 à 10 pour cent. L’attente des patients en milieu
hospitalier a été grandement réduite puisque ceux-ci se présentaient
une heure, et non trois heures, avant la chirurgie planifiée. Les
patients marchaient pour se rendre à la salle d’opération au lieu
d’être transportés sur une civière, ce qui permettait aux employés
d’économiser du temps. Health Edition 11/07/2008
 Some Quebec hospitals are not fulfilling their legal responsibilities
to track medical errors which were part of Bill 113 in 2002. The
province’s 300 hospitals were supposed to set up boards to manage
risks, and 240 have done so as of end of 2005. Furthermore, only 227
have a program for disclosing medical errors. The health ministry
says there have been improvements in these rates since then, and
this year there will be provincial reporting on the incidence of
medical errors. Health Edition 2008/05/14
 Certains hôpitaux du Québec n’assument pas leurs responsabilités
légales en matière de signalement des erreurs médicales en vertu du
projet de loi 113 adopté en 2002. Les 300 hôpitaux de la province
devaient mettre sur pied des conseils en vue de gérer les risques; 240
d’entre eux répondaient à cette exigence à la fin de l’année 2005. De
plus, seulement 227 hôpitaux sont munis d’un programme de
signalement des erreurs médicales. Le ministère de la Santé
confirme que ces chiffres ont connu une amélioration depuis 2005 et
que cette année, on procédera à la déclaration provinciale de
l’incidence des erreurs médicales. Health Edition 14/05/2008
There are two ROPs on adverse
events, sentinel events, and
near misses—establishing a
reporting system and
implementing policies and
procedures.
Il existe deux POR portant sur
les événements indésirables, les
événements sentinelles, de
même que les incidents et
accidents évités de justesse, qui
établissent un système de
déclaration et de mise en œuvre
des politiques et procédures.
21
Health Care
Restructuring/
Systems Issues
SK
 Saskatchewan’s “patient-first review” of the health system could be
underway next month. The Saskatchewan Party committed to this
review in last November’s provincial election, and has long talked
about the need to redirect health care dollars from bureaucracy, red
tape, and unnecessary duplication to improving front-line care.
 The party, now in government, has made no secret of its
dissatisfaction with the province’s regional health structure. NDP
Health Critic Judy Junor suspects the government is going to travel
down the same path as its Alberta neighbour and do away with
regions altogether.
 While governance issues are not the point of the review, they could
possibly be addressed. The review will look at how to improve
access to systems, building capacity and new models of care, as well
as to improve the workplace and make things more efficient. Health
With the reshaping of how
health services are provided in
different provinces, it is
important that Accreditation
Canada continue to work with
the provinces and their
ministries to ensure the
accreditation program remains
relevant and responsive,
respecting provincial/territorial
differences yet ensuring the
integrity of the program.
Edition 2008/07/18
Items have been compiled from Canada’s Health Newsweekly Health Edition, Government of Alberta, CTV.ca News, Toronto Star, Times Colonist
(Victoria), Leader-Post (Regina), Globe and Mail, and Canadian Press.