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Metrics for HealtHcare Quality tHe leader's role by vqx13199


									2010  2010

     Metrics for
 HealtHcare Quality:
  tHe leader’s role

     Montréal, Quebec
     February 17, 2010

table of contents

Page 2 ..............................          Background
Page 3 ..............................          Welcome
Page 4 .............................           Agenda
Page 9 ..............................          Recipient of Excellence through Evidence
Page 10 ...........................            The Quality and Performance of Canadian
............................................   Healthcare – A Briefing
Page 16 ...........................            Sample Charter Statement on Quality
Page 17 ...........................            Speaker Biographies

The CEO Forum is a one-day, invitation-only event that brings together CEOs, policy-
makers and experts to share their knowledge, perspectives and experience on key
issues in healthcare policy and management. This annual gathering grew out of the
Executive Training for Research Application (EXTRA) program, a two-year fellowship for
senior health leaders and policy-makers. (Find out more about EXTRA at
extra.) The forum takes place during the last learning module of the EXTRA program,
when fellows and their chief executives present the findings of an evidence-informed
intervention project they have undertaken within their organizations. In 2009, its third
year, the conference expanded beyond the EXTRA community to include senior decision-
and policy-makers, as well as prominent experts from across Canada. Also, CHSRF
welcomed the Association of Academic Healthcare Organizations and the Canadian
Medical Association as partners for the CEO Forum in 2009.

2   | Metrics for HealtHcare Quality: tHe leader’s role |

Dear Colleagues,

We are pleased to welcome you to the fourth annual CEO Forum – Metrics for
Healthcare Quality: The Leader’s Role.
Whether at the level of the institution, health region, province or territory, improving
quality and performance requires considerable co-ordination and collaboration. It also
requires a concerted effort to bring about cultural change.
The CEO Forum is a venue for you as leaders – CEOs, policy-makers and experts – to
confront and discuss the challenges of driving quality and performance in your own
organizations and jurisdictions. In setting your sights on delivering high-quality patient
care, you are encouraged to use this forum as an opportunity to exchange ideas on
how to implement improvement strategies that are evidence-driven, effective and
We also invite you to join us at the dinner to close the event, when we will present
CHSRF’s 2010 Excellence through Evidence, an award recognizing a health services leader
who has successfully implemented evidence-informed innovation in care and service
delivery in Canada.
Thank you for your participation. We look forward to engaging with you in this forum.


Maureen O’Neil                    Paul-Émile Cloutier               Glenn Brimacombe
President                         Secretary General and Chief       President and
Canadian Health Services          Executive Officer                 Chief Executive Officer
Research Foundation               Canadian Medical Association      Association of Canadian
                                                                    Academic Healthcare

       Metrics for HealtHcare Quality: tHe leader’s role | |                        3

       2010 ceo Forum – metrics For healthcare
       Quality: the leader’s role
       Wednesday, February 17, 2010
       hotel omni mont-royal, montréal, Quebec

       top Five takeaways
       • Meet and exchange ideas with peers and prominent experts
       • Work toward establishing a common vision for improving quality
         and performance
       • Discuss a core set of measures to monitor and report on quality
         and performance
       • Get practical advice on ways to turn data into useful information
       • Share strategies to drive improvement in quality and performance

       Framing Questions
       • How can we build a cross-jurisdictional, unifying framework on which
         common dimensions of quality can be reported at the provincial,
         territorial and institutional levels, across the continuum of care?
       • What are the levers for achieving quality patient care? Should we build
         stronger incentives and sanctions for quality? What is the role
         of governance?
       • How can we use information and communication technologies wisely
         to manage demands in health services and improve the quality of
         patient care?

       7:30–9:00               registration and breakfast
       9:00–9:45               welcome, introductions
                               and framing the day
                               Terry Sullivan, President and CEO, Cancer Care
                               Ontario (moderator)

       9:45–10:15              case study i – Focus on Quality: the
                               ottawa hospital experience
                               Jack Kitts, President and CEO, The Ottawa Hospital

4   | Metrics for HealtHcare Quality: tHe leader’s role |

 10:15–10:30             refreshment break
 10:30–11:00             case study ii – Quebec’s continuous
                         improvement in traumatology Program
                         Juan Roberto Iglesias, President and CEO, Agence
                         d’évaluation des technologies et des modes
                         d’intervention en santé

 11:00–11:30             case study iii – the Big dots: managing
                         What you’re measuring
                         Maura Davies, President and CEO, Saskatoon
                         Health Region

 11:30–12:00             q&A
 12:00–13:00             lunch break
 13:00–13:15             prep for breakout sessions
 13:15–14:45             breakout sessions (i–iv)

sessioN i: Building a minimum Quality indicator set (Salon Été)
          Ben Chan, CEO, Ontario Health Quality Council
          John Cowell, CEO, Health Quality Council of Alberta
          Wendy Nicklin, President and CEO,
          Accreditation Canada
          Micheline Ste-Marie, Présidente, Groupe Vigilance pour la
          sécurité des soins
          Facilitator: Jennifer Thornhill, Senior Advisor, Policy, Canadian
          Health Services Research Foundation
          • To provide an overview of quality dimensions and
            frameworks in use across Canada
          • To identify the “big dot” indicators for a specific set of
            quality dimensions
          • To discuss strategies for working toward a minimum set of
            national standardized quality indicators

Metrics for HealtHcare Quality: tHe leader’s role | |                5

       sessioN ii: Working toward a charter for Quality in healthcare (Salon Printemps)
                  Bonnie Brossart, CEO, Health Quality Council, Saskatchewan
                  Adalsteinn Brown, Assistant Deputy Minister, Health System Strategy
                  Division, Ministry of Health and Long-Term Care, Ontario
                  Robert Ouellet, Past-President, Canadian Medical Association
                  Facilitator: Owen Adams, Assistant Secretary General, Research,
                  Policy & Planning, Canadian Medical Association
                  • To provide an overview of patient-centred care and how to
                    achieve it
                  • To explore one provincial and one national initiative for
                    achieving high-quality patient care; namely, to gain insights from
                    Saskatchewan’s Patient First Review and the Canadian Medical
                    Association’s efforts toward a Patient Quality Charter
                  • To consider strategies for aligning healthcare infrastructure
                    to support a continuous focus on quality and performance

       sessioN iii: managing health information technology to maximize outcomes
                    and Benefits (Salon des Saisons A)
                   Yeona Jang, Professor of Practice, Desautels Faculty of Management,
                   McGill University
                   Elissa F. Malcolm, Quality Measurement Analyst, Quality & Patient
                   Safety, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock
                   Medical Center
                   Melanie Mastanduno, Director of Population Health Measurement,
                   The Dartmouth Institute for Health Policy and Clinical Measurement
                   Robyn Tamblyn, Professor, Clinical and Health Informatics Research
                   Group, Medicine and Department of Epidemiology, Biostatistics, and
                   Occupational Health, McGill University
                   Facilitator: Jennifer Ellis, Director, Policy, Canadian Health Services
                   Research Foundation

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           • To define success and failure in managing information
             technology (IT) in the context of enhancing the quality and
             performance of health systems
           • To share lessons learned from industries and gain insights in
             better managing large-scale IT investment to drive toward an
             organization’s goals
           • To provide practical guidance for organizations embarking on
             a journey toward transparency, including the key technological
             components for turning data into information

sessioN iV: Finding levers to improve Quality (Salon des Saisons B)
            G. Ross Baker, Professor, Health Policy, Management and
            Evaluation, Faculty of Medicine, University of Toronto
            Oliver J. Warren, Honorary Clinical Research Fellow, Division
            of Surgery, Oncology, Reproductive Biology and Anaesthetics,
            Imperial College, London
            Facilitator: David Clements, Vice-President, Policy, Canadian
            Health Services Research Foundation
            • To explore levers, incentives and sanctions for improving
              quality and performance in healthcare
            • To provide insights into the role of governance in prioritizing
              quality and safety
            • To consider the role of physician leadership and engagement
              in quality improvement initiatives

 14:45–15:00             refreshment Break

Metrics for HealtHcare Quality: tHe leader’s role | |                  7

       15:00–15:45       report back
                         session i: Ben Chan, CEO, Ontario Health
                         Quality Council
                         session ii: Adalsteinn Brown, Assistant Deputy
                         Minister, Health System Strategy Division, Ministry
                         of Health and Long-Term Care, Ontario
                         session iii: Robyn Tamblyn, Professor, Clinical and
                         Health Informatics Research Group, Medicine and
                         Department of Epidemiology, Biostatistics, and
                         Occupational Health, McGill University
                         session iV: G. Ross Baker, Professor, Health Policy,
                         Management and Evaluation, Faculty of Medicine,
                         University of Toronto
                         moderator: Terry Sullivan, President and CEO,
                         Cancer Care Ontario

       15:45–16:30       plenary discussion
                         Review of the day and Charter Statement on Quality

       16:30–17:00       reception
       17:00             award presentation
                         and dinner
                         Excellence through Evidence, an award celebrating
                         innovative leaders in health services

8   | Metrics for HealtHcare Quality: tHe leader’s role |
                    CHSRF proudly recognizes

Dr. Judith Ritchie
the 2010 recipient of Excellence through Evidence – awarded
to a health services leader who has successfully implemented
  evidence-informed innovations in care and service delivery.
The award selection committee has chosen Dr. Ritchie for
the quality of leadership demonstrated throughout her career
in promoting the use of evidence to shape and improve the
                    delivery of patient care.
In her current position at the McGill University Health
Centre, Dr. Ritchie is recognized for her ability to mentor
senior health executives and mobilize clinical care teams to
value a spirit of inquiry and strive to improve outcomes. She
has spearheaded the implementation of best practice guidelines
that have brought measurable improvements to patient safety
                      and quality of care.
Her dedication to putting the best evidence into practice has
created a culture of evidence-informed decision-making across
the organization and has earned her the respect of everyone –
              from the bedside to the boardroom.
     (For more information on Dr. Ritchie and Excellence through Evidence,
                             please visit

the Quality and Performance of canadian healthcare – a Briefing
By Laura Fletcher and Stephen Petersen
Numerous surveys have taken the Canadian pulse on healthcare quality. Just recently, a 2009
health consumer surveyi reported that 62% of patients who recently visited a hospital were
satisfied with the care they received. A 2008 Health Canada study ii showed even stronger
support, with Canadians reporting an 85% rate of satisfaction with the way healthcare
services are provided. Despite these public votes of confidence in Canadian healthcare,
international comparative data suggest Canada is falling behind in achieving high-quality
healthcare. A 2007 Commonwealth Fund reportiii ranked Canada fourth out of six Western
nations on performance overall, and last for delivering effective, co-ordinated, patient-
centred care. With respect to healthcare infostructure, Canada has been the target of a great
deal of criticism for its sizeable investments in information technology and disproportionately
small return in terms of improved co-ordination and patient outcomes on such investments.
Other studies have cited Canada as having poor access to care, low immunization rates,
limited technical infrastructure, discrepancies in services across regions with varying degrees
of rurality, and high mortality rates due to cancer, diabetes, and other common diseases.iv, v
The Canadian public may not fully appreciate what it means to receive quality care. Recent
public discourse has focused on issues of access (or more specifically, wait times) and patient
safety. High-quality care rests on the identification, monitoring, analysis and decision-making
based on a far wider range of indicators.
a broader definition of healthcare quality
The literature provides varying definitions for quality of care. The Institute of Medicine
(IOM) first defined quality of care as “the degree to which health services for individuals
and populations increase the likelihood of desired health outcomes and are consistent with
current professional knowledge.”vi The U.S. Agency for Healthcare Research and Quality
advocates for quality healthcare that does “the right thing at the right time in the right
way for the right person and [has] the best results possible.” Despite good intentions, it is
argued that these definitions portray a limited view of quality, placing too much emphasis
on “effectiveness” from a technical or clinical standpoint.vii It is for this reason that the IOM,
the World Health Organization, and the Canadian Institute for Health Information (CIHI),
along with a host of other national and international organizations, have developed their
own frameworks by which to depict quality and its multiple dimensions. These frameworks,
which generally consist of anywhere from six to fifteen dimensions of quality, can be used to
evaluate a variety of factors that collectively contribute to overall quality of healthcare.vii, viii, ix

10    | Metrics for HealtHcare Quality: tHe leader’s role |

                                                  In Canada, a number of organizations,
                                                  operating at the provincial or national
                                                  level, have established their own quality
                                                  frameworks (see Table 1 on page 15 for
                                                  a comparison). Across organizations,
                                                  similarities and differences will exist.
                                                  What’s important is that the dimensions
                                                  that are included reflect organizational
                                                  needs and priorities, as well as an
                                                  alignment with the performance-
                                                  monitoring activities in any given context
                                                  or jurisdiction.
Across various healthcare contexts, some dimensions tend to surface more than others.
A 2006 Organisation for Economic Co-operation and Development (OECD) report found
that the six most frequently used dimensions of quality internationally included equity,
effectiveness, efficiency, accessibility, safety, and appropriateness. In Canada, Accreditation
Canada is the national body responsible for providing external peer review to assess and
improve the quality and performance of services provided by healthcare organizations.
Provinces have also been doing their part to promote and support quality improvements
in healthcare organizations by establishing provincial health quality councils. When the
Saskatchewan Health Quality Council was established in 2002, it was the first of its kind in
Canada. Since then, other provincial health quality councils, with varying mandates, have
been initiated across the country.
Frameworks developed by these and other Canadian organizations frequently list four key
quality dimensions: effectiveness, efficiency, accessibility, and safety.x Of course, ideas of
the most important dimensions of quality will change with the culture and values of the
healthcare system as a whole. If certain priorities are addressed, new dimensions of quality
are likely to emerge.
Patient-centredness and healthcare quality
Patient-centredness, for example, is a quality dimension that has been garnering increased
attention in recent years. To achieve quality in healthcare, some have suggested drawing
from business models, in which a philosophy of “the customer (patient) is always right”
prevails. The underlying notion that unconditionally respecting patients’ intelligence,
adjusting to their preferences, and being sensitive to their needs along the continuum of
care are major determinants of patient satisfaction — and thereby quality — is certainly
appealing. The major question to be asked, though, is, “What is the best way to achieve
patient-centred care?”

     Metrics for HealtHcare Quality: tHe leader’s role | |                          11

One provincial initiative began in November 2008, when the province of Saskatchewan
kicked off its Patient First Review. Although patient- and family-centred approaches to
healthcare have been a major force in the improvement of healthcare quality for several
decades, this review was the first of its kind in Canada.xi A major component of the review
was an investigation of the healthcare system from the patient’s perspective, as well as the
delivery of actionable recommendations for change based on scrupulous patient, family,
and citizen consultation. In October 2009, the commissioner of the review, Tony Dagnone,
presented the results to the health minister. The primary recommendation was to “make
patient- and family-centred care the foundation and principal aim of the Saskatchewan
health system, through a broad policy framework to be adopted system-wide.” Essentially,
Mr. Dagnone recommended a cultural shift toward patient-centredness.
Since then, the Canadian Medical Association (CMA) has embarked on its own patient
initiative aimed at improving quality of healthcare and, specifically, to promote a shift in the
values and culture that currently drive the healthcare system. In late 2009, CMA President-
Elect Anne Doig announced the CMA’s intention to draft and facilitate the widespread
adoption of a Patient Quality Charter.xii The proposed charter will be written from the
patient perspective and aims to set a vision for quality care that includes national standards
for optimal patient-focused outcomes. As envisioned, healthcare providers (professionals
and their organizations) would be accountable to the proposed charter and would make a
concerted effort to understand patient needs and respect their time, preferences,
and intelligence.
strategies for healthcare quality and performance improvement
Driving improvements in quality and performance in healthcare, although complex, can be
done. Canadian healthcare CEOs, responsible for reporting on a range of quality indicators
(as per accountability agreements, public reporting requirements, and other federal and
provincial quality improvement initiatives), are under particular pressure not to fall victim to
what has been dubbed “indicatoritis” – a case of too many quality indicators with too little
wherewithal for knowing what to collect, how to measure, to whom to report and so forth.
As one hospital CEO describes, “If you are chasing 54 priorities you are not really chasing any
of them adequately.”xiii Still, CEOs must find ways to align their own targets and priorities with
those that are mandated.
While managing these complexities, healthcare organizations must not lose sight of the
forest for the trees. Having a quality framework in place with a catalogue of appropriate
indicators is indeed necessary, but it’s insufficient for cultivating performance and quality
improvement. It is arguably more important to shift attention toward boards and governance
in healthcare, as they can be a more effective lever to drive improvements in healthcare
quality. Recent research and policy discussions in Canada and the U.S. suggest that healthcare

12   | Metrics for HealtHcare Quality: tHe leader’s role |

                                                    boards and governance often fail to set
                                                    goals or monitor progress, and do not hold
                                                    CEOs accountable for performance related
                                                    to the quality and safety of care. To achieve
                                                    governing responsibilities with respect
                                                    to quality and safety, health boards must
                                                    perform a variety of functions. They must
                                                    endorse goals of high quality and improved
                                                    patient safety by developing a vision
                                                    consistent with these goals. Boards should
                                                    also see it as their responsibility to access,
                                                    interpret, and use valid and appropriate
information to monitor quality and performance related to these goals. Organizational boards
are also in a unique position to support initiatives that develop a culture of quality and safety.xi
Another example of a quality-improvement initiative is QQUIP (Quest for Quality and
Improved Performance), a research initiative in England that investigates interventions
to improve healthcare quality and performance, and aims to determine if the National
Health System (NHS) is getting value for money.xiv QQUIP uses a three-pronged approach to
improving the NHS: a quality information centre (an online resource, home to 150 charts
of easily accessible, at-a-glance data on national and international trends in quality and
performance); value-for-money analyses (insights into expenditures, outputs, and outcomes
alongside assessments of where money might be spent to greatest effect); and quality-
enhancing interventions (a series of structured, evidence-based reviews of the effectiveness
of a wide range of interventions designed to improve quality of healthcare).
For its part, the Canadian Health Services Research Foundation (CHSRF), in collaboration
with the Canadian Institute for Health Information (CIHI), the Canadian Patient Safety
Institute (CPSI), and Statistics Canada, has jointly commissioned Quality of Healthcare in
Canada: A Chartbook.iv The chartbook provides data on the quality and performance of
healthcare, in Canada and internationally, serving as a tool to inform policy and management
decision-making, to identify gaps in data, to highlight potential areas for investment in
quality improvement, and to provide an important baseline for future analysis. The Canadian
chartbook is comparable to chartbook initiatives elsewhere – specifically, the U.S., the U.K.
and Australia have each compiled data on quality of care and service delivery to patients,
allowing comparisons of quality on an international scale.
in closing
Improving healthcare quality is a perennial challenge for all healthcare systems and for
all those invested in the health and well-being of patients. Without question, there are

      Metrics for HealtHcare Quality: tHe leader’s role | |                            13
difficulties in effecting quality and performance improvements and standardizing a global
set of quality indicators amid local priorities. However, there are many exemplary initiatives
demonstrating that healthcare leaders and workers are committed to improving the quality
of healthcare and that quality improvement is effectively occurring, albeit in a fractured way,
not only across Canada but around the world.

i.      Fam, M. and Purdy, L. (2009). Treating patients as consumers: 2009 Canadian health care
        consumer survey report. Deloitte.
ii.     Health Canada. (2008). Healthy Canadians—A Federal Report on Comparable Health Indicators.
        Retrieved from
iii.    Davis, K., Schoen, C., Schoenbaum, S. C., Doty, M. M., Holmgren, A. L., Kriss, J. L., et al. (2007).
        Mirror, mirror on the wall: An international update on the comparative performance of
        American health care. The Commonwealth Fund.
iv.     Sutherland, K. and Leatherman, S. (2010). Quality of Healthcare in Canada: A Chartbook.
        Canadian Health Services Research Foundation. Retrieved from
v.      McMurchy, D. (2009). What are the critical attributes and benefits of a high-quality primary
        healthcare system? Canadian Health Services Research Foundation and the Canadian Institutes
        of Health Research. Retrieved from
vi.     Lohr, K. (1990). Medicare: A strategy for quality assurance. Institute of Medicine, Washington,
        DC: National Academy Press.
vii.    Docteur, E. and Berenson, R. (2009). How does the quality of U.S. health care compare
        internationally? Timely analysis of immediate health policy issues. Robert Wood Johnson
        Foundation and the Urban Institute.
viii.   Vigneault, S. (2007). Environmental scan: Managing for quality and safety. Canadian Health
        Services Research Foundation. Retrieved from
ix.     Peters, J. and Nicklin, W. (2007). Quality Frameworks: National & International Overview –
        Common/Unique Dimensions & Key Messages (unpublished meeting report).
x.      Kelley, E. and Hurst, J. (2006). Health care quality indicators project: Conceptual framework
        paper. Organisation for Economic Co-operation and Development Health Working Papers.
xi.     Government of Saskatchewan. (2008). “Patient first” review launched—First of its kind in
        Canada. Retrieved from
xii.    Doig, A. (2009). Health care must be about patients not politics. Canadian Medical Association.
        Retrieved from
xiii.   Baker, G. R., Denis, J., Pomey, M., Macintosh-Murray, A. (2008). Effective governance for quality
        and patient safety in Canadian Healthcare organizations: A report to the Canadian Health
        Services Research Foundation and the Canadian Patient Safety Institute.
xiv.    The Health Foundation. (n.d.). Quest for Quality and Improved Performance.

                                                                 table 1: dimensions of healthcare quality by organization and jurisdiction

                                                                       most                Quality          accreditation         Bc Patient            health           saskatchewan             ontario    Province of      New
                                                                  frequently used        dimension            canada               safety &            Quality               health                health     Quebec6      Brunswick
                                                                    dimensions                                                      Quality           council of            Quality               Quality                    health
                                                                  internationally1                                                 council2            alberta3             council4              council5                  council7
                                                                                       Acceptable                                       n                   n                    n

                                                                          X            Accessible/
                                                                                                                   n                    n                   n                    n                    n          n            n
                                                                          X            Appropriate                                      n                   n                    n                                            n

                                                                                        Appropriately                                                                                                 n
                                                                                       Competence                                                                                n

                                                                                       Continuity                  n                                                             n                               n

                                                                          X            Effective                   n                    n                   n                    n                    n          n            n

                                                                          X            Efficient                   n                    n                   n                    n                    n          n            n

                                                                          X            Equitable                                        n                                        n                    n                       n

                                                                                       Integrated                                                                                                     n

                                                                                       Patient/Client              n                                                             n                    n          n            n
                                                                                       Population                  n                                                                                  n          n            n
                                                                          X            Safe                        n                    n                   n                    n                    n          n            n

                                                                                       Worklife                    n                                                                                             n

                                                                 source: Adapted with permission from Accreditation Canada (formerly Canadian Council on Health Services Accreditation). (June 2007).
                                                                 “Quality Frameworks: National and International Overview, Common/Unique Dimensions & Key Messages.”
                                                                 Note: Shaded rows indicate common dimensions across all organizations.
                                                                   Kelley, E. and Hurst, J. (2006). Health Care Quality Indicators Project: Conceptual Framework Paper. OECD Health Working Papers.
                                                                   BC Patient Safety and Quality Council. (2009). BC Health Quality Matrix. Retrieved from

Metrics for HealtHcare Quality: tHe leader’s role | |
                                                                   Health Quality Council of Alberta. (2009). Alberta Quality Matrix for Health. Retrieved from

                                                                   Saskatchewan Health Quality Council. (2009). Quality Insight—Dimensions of Quality. Retrieved from

                                                                   Ontario Health Quality Council. (2009). 2009 Report on Ontario’s Health System. Retrieved from
                                                                   LSSS, L.R.Q., chapitre S-4.2 Loi sur les services de santé et les services sociaux. Retrieved from
                                                                   New Brunswick Health Council. (2009). Quality Dimensions. Retrieved from
sample charter statement on Quality
The following is offered as a sample charter statement on quality, with CEOs and their Board
Chairs as intended signatories. This statement will inform discussion at the CEO Forum.
During the final session, participants will be invited to provide comment on the charter, as
well as to consider its application and relevance in their own context.
a charter on improving the Quality of Patient care
Our healthcare organizations believe in the importance of a system of publicly funded health
services and the need to ensure its sustainability for future generations. As organizations
providing healthcare, we further acknowledge our accountability for the quality of services
delivered to patients and their families. We endeavour to create a system where healthcare
organizations are continually focused on improving the quality of services they deliver,
and where clients of healthcare organizations have both excellent clinical outcomes and
consistently positive experiences.
We aim to provide patients with a high-quality healthcare system that is accessible, safe,
patient-centred, appropriate, effective, efficient, equitable, integrated, and focused on
population health. In order to continually deliver this level of quality service to patients, we
agree that:
• our boards of directors will recognize their responsibility for overseeing the quality of care
  provided in their organizations;
• our organizations will establish and maintain high-functioning board quality committees;
• our organizations will implement, and make public, annual quality improvement plans;
• our organizations will remain committed to transparency by reporting publicly on progress
  toward quality targets;
• our organizations will implement standardized patient/client/caregiver experience surveys
  and healthcare worker satisfaction surveys, reflecting experience within the healthcare
  system as well as transitions from the system to the patient’s home or to another
  institution, which can be compared and benchmarked;
• our organizations will financially reward our chief executives for success in achieving
  specific quality targets.
We believe that setting out clearly the responsibilities and accountabilities of healthcare
organizations for continuous quality improvement will contribute to increased access to
health services by improving outcomes and eliminating inefficient practices.
We remain committed to transparency in the system in order to assure the public that the
healthcare system is focused on and fosters continuous quality improvement.
We do all this because we are working toward making our healthcare organizations the best
in Canada and in the world.

16   | Metrics for HealtHcare Quality: tHe leader’s role |

speaker biographies

              g. ross baker
              Professor, health Policy, management and evaluation
              university of toronto
              Dr. Baker, together with Dr. Peter Norton of the University of
              Calgary, led the Canadian Adverse Events study, published in the
              Canadian Medical Association Journal in 2004. Baker and Norton
              were awarded CHSRF’s Health Services Research Advancement
              Award in May 2009 for their work on patient safety and quality
              Dr. Baker co-chairs a working group on methods and measures for
              patient safety for the World Health Organization and chairs the
              Advisory Committee on Research and Evaluation for the Canadian
              Patient Safety Institute. He is a member of the board of the Health
              Quality Council of Saskatchewan, the board of the Institute for Safe
              Medication Practices (ISMP) Canada, and the Clinical Standards,
              Guidelines and Quality Committee of Cancer Care Ontario.
              In October 2008, he published a book, High Performing Healthcare
              Systems, which analyzes seven healthcare systems that have
              successfully used improvement tools and knowledge to transform
              outcomes. Other recent research projects include a study of
              effective governance practices in improving quality and patient
              safety. In 2007, Dr. Baker was awarded the Filerman Prize for
              Innovation in Health Management Education by the Association of
              University Programs in Health Administration (AUPHA).

              Adalsteinn d. brown
              assistant deputy minister, health system strategy division
              ministry of health and long-term care, ontario
              Adalsteinn (Steini) D. Brown was appointed as the Assistant Deputy
              Minister, Health System Strategy Division, Ontario’s Ministry of
              Health and Long-Term Care (MOHLTC) in March 2006, with the goal
              to establish overall strategic directions and provincial priorities for
              the health system. He is an assistant professor in the Department
              of Health Policy, Management and Evaluation (HPME), Faculty of
              Medicine, at the University of Toronto. He received his D.Phil from
              the University of Oxford and was a Rhodes Scholar. He was named
              one of Canada’s “Top 40 Under 40” in 2003.

  Metrics for HealtHcare Quality: tHe leader’s role | |                 17
speaker biographies

                 bonnie brossart
                 chief executive officer
                 health Quality council, saskatchewan
                 Bonnie Brossart has been with the Health Quality Council since
                 its launch in January 2003. Prior to her appointment as CEO, she
                 served as interim CEO for five months and deputy CEO for just over
                 three years, and also co-led the Saskatchewan Chronic Disease
                 Management Collaborative, one of the largest quality improvement
                 initiatives the province has ever undertaken. Before joining HQC
                 she was a health services researcher with the Health Services
                 Utilization and Research Commission (HSURC) of Saskatchewan,
                 and also worked at a large tertiary hospital in Calgary and with the
                 Saskatchewan Ministry of Health.
                 Bonnie’s research background has considerable breadth. She has
                 participated in and led research on a variety of groundbreaking
                 projects, including a number of regional variations in healthcare
                 analyses, and an evaluation of the cost-effectiveness of post-acute
                 home care. She also led a comprehensive, innovative research project
                 on quality of care for rural Saskatchewan residents, following acute-
                 care funding cuts to rural hospitals in the early 1990s.
                 Bonnie Brossart received her BA (Economics) from the University of
                 Calgary and her MA (Economics) from McMaster University.

                 ben chan
                 chief executive officer
                 ontario health Quality council
                 Dr. Ben Chan is the inaugural CEO of the Ontario Health Quality
                 Council. In his previous role as inaugural CEO of Saskatchewan’s
                 Health Quality Council (HQC), Dr. Chan led an ambitious agenda
                 to report to the public on quality and implement quality
                 improvement programs to improve chronic disease management,
                 reduce wait times and prevent adverse events. In 2006, the HQC
                 received the Saskatchewan Health Excellence Award for its work.
                 Dr. Chan has been named Canada’s Outstanding Young Health
                 Executive by the Canadian College of Health Service Executives,
                 and Distinguished Alumnus of the Year by Victoria College,
                 University of Toronto.
                 As a former senior scientist with the Institute for Clinical Evaluative
                 Sciences, Dr. Chan authored over 60 publications. He has worked
                 as a part-time locum general practitioner in 70 rural communities
                 across Canada. He received his BSc and MD from the University
                 of Toronto, holds a Master’s of Public Health from Harvard and a
                 Master’s of Public Affairs from Princeton.

18   | Metrics for HealtHcare Quality: tHe leader’s role |

            john w. cowell
            chief executive officer
            health Quality council, alberta
            Dr. John Cowell became the chief executive officer of the Health
            Quality Council of Alberta in January 2003. In prior years, Dr.
            Cowell served as president and chief executive officer of the
            Workers’ Compensation Board – Alberta, as vice-president of
            Health, Safety and Environment for Nova Corporation of Alberta,
            and as the medical director of General Electric Canada. Dr. Cowell
            graduated from the University of Toronto with an M.Sc and
            MD. He is Royal College-certified in occupational medicine and
            has certifications from the College of Family Medicine and the
            Canadian Board of Occupational Medicine.

            maura davies
            President and chief executive officer
            saskatoon health region
            Maura Davies is the president and chief executive officer of
            the Saskatoon Health Region, the largest health region in
            Saskatchewan, which provides a comprehensive range of services
            and programs including acute care, long-term care, public health,
            home care, and mental health and addiction services.
            Maura has over 35 years of experience in healthcare as a clinical
            dietitian, educator and senior executive. She has a bachelor’s
            degree in science, a bachelor’s degree in education, and a
            master’s degree in health services administration. Maura is a
            fellow of the Canadian College of Health Service Executives and
            a surveyor for Accreditation Canada. She is on the boards of
            directors for the Canadian Patient Safety Institute, Association
            of Canadian Academic Healthcare Organizations, Saskatchewan
            Academic Health Sciences Network and Saskatchewan Health
            Quality Council. She holds a part-time faculty appointment in
            the Department of Community Health and Epidemiology at the
            University of Saskatchewan. Maura has been recognized as one of
            the Top 10 Women of Influence in Saskatchewan by Saskatchewan
            Business Magazine and as one of Canada’s Top 100 Most Powerful
            Women by the Women’s Executive Network.

Metrics for HealtHcare Quality: tHe leader’s role | |             19
speaker biographies
                 juan roberto iglesias
                 chief executive officer
                 agence d’évaluation des technologies et des modes
                 d’intervention en santé
                 A graduate in medicine from the Université de Sherbrooke, holder of
                 a master’s degree in science (cellular biology) and having completed
                 postdoctoral studies in epidemiology at McGill University, Dr. Iglesias
                 has been in charge of the Agence d’évaluation des technologies et
                 des modes d’intervention en santé (AETMIS) since 2006. He has
                 extensive experience in the health and social services network and
                 the public sector. He has held the positions of assistant deputy
                 minister of Public Health and associate deputy minister of Cross-
                 Sectoral Coordination (1989-1993), and deputy minister (2003-
                 2006) at the Ministère de la Santé et des Services sociaux. He was
                 also chair of the Conseil médical du Québec and assistant dean for
                 the Université de Sherbrooke’s Faculty of Medicine. Before that,
                 he worked as full professor at the Université de Sherbrooke and as
                 a family physician at the Farnham CLSC (Centre local des services
                 communautaires). Dr. Iglesias actively participated in the work of the
                 Institut national d’excellence en santé et services sociaux’s (INESSS)
                 establishment committee.

                 Yeona Jang
                 Professor of Practice in management
                 desautels Faculty of management
                 mcGill university
                 Dr. Yeona Jang joined the Desautels Faculty of Management at McGill
                 University in 2007, with 15 years of experience in IT management and
                 consulting as a senior executive and decision maker in various companies
                 in the corporate world.
                 She has proven hands-on experience in IT strategy, IT-enabled innovation
                 and transformation, software product development, large-scale systems
                 integration, IT outsourcing and vendor management, and IT governance.
                 Dr. Jang’s main focus is on helping organizations use information
                 technology to drive changes for higher performance and innovation:
                 not “What worked in the past and how do we repeat it?” but “What’s
                 necessary for the future and how do we create it?” Her current research
                 focus is on advancing IT-to-value pathways in medical informatics, as well
                 as knowledge management as an integral part of business.
                 Topics she is passionate about include: how business and IT can no
                 longer be separate – IT is part of the business; why large-scale IT projects
                 typically fail from business (not IT) mismanagement and how to manage
                 it; and how knowledge management can unlock collaborative capacity
                 for higher performance and innovation.

20   | Metrics for HealtHcare Quality: tHe leader’s role |
           jack kitts
           President and chief executive officer
           the ottawa hospital
           Dr. Jack Kitts graduated from the Faculty of Medicine, University of Ottawa,
           in 1980 and completed his internship at the University of Toronto in 1981.
           From 1981 to 1984, Dr. Kitts served as a medical officer in the Canadian
           Armed Forces. From 1986 to 1988, Dr. Kitts completed specialty training in
           anesthesia at the University of Ottawa and the University of California in
           San Francisco.
           Dr. Kitts joined the Department of Anesthesiology at the Ottawa Civic
           Hospital in 1988. In 1995, he was appointed Chief of the Department of
           Anesthesiology and was named associate professor of anesthesia at the
           University of Ottawa in 1996.
           Dr. Kitts was appointed vice-president of Medical Affairs for The Ottawa
           Hospital in 1998. After receiving a master’s in business administration from
           the University of Ottawa in 2001, Dr. Kitts was appointed president and
           CEO of The Ottawa Hospital in February 2002.

           elissa f. malcolm
           Quality measurement analyst
           dartmouth-hitchock medical center
           Ms. Malcolm is Quality Measurement Analyst at Dartmouth-Hitchcock
           Medical Center (DHMC) in Lebanon, New Hampshire. She provides
           measurement and analysis for the Children’s Hospital at Dartmouth and is
           the project manager for quality and cost reporting on the DHMC website.
           The nationally recognized website, “Quality Reports,” provides process,
           outcome, satisfaction, and cost information for patients and families on a
           broad range of conditions and procedures. Ms. Malcolm has spent more
           than 100 hours interviewing patients and families on their perceptions of
           “Quality Reports.” Ms. Malcolm completed her MS in the evaluative clinical
           sciences at The Dartmouth Institute for Health Policy and Clinical Practice.

           melanie p. mastanduno
           director, Population health measurement
           center for Population health, the dartmouth institute of health
           Policy and clinical Practice
           As director, Ms. Mastanduno co-ordinates population health measurement
           strategies for projects within the Prevention Research Center at Dartmouth.
           While at Dartmouth-Hitchcock Medical, she launched “Quality Reports,” a
           website providing information on clinical outcomes, patient satisfaction and
           charges for many hospital and ambulatory services. She also has expertise
           in population risk assessment and severity adjustment methodologies, and
           has overseen data collection, analysis and report generation for numerous
           projects. Her career path has included management positions at General
           Electric’s Aerospace Division and The Codman Research Group, Inc. She
           holds a professional nursing degree and an MPH from The Johns Hopkins
           University School of Hygiene and Public Health.

Metrics for HealtHcare Quality: tHe leader’s role | |                     21
speaker biographies
                 wendy nicklin
                 President and chief executive officer
                 accreditation canada
                 Wendy Nicklin is the president and chief executive officer of
                 Accreditation Canada, formerly known as the Canadian Council
                 on Health Services Accreditation (CCHSA). Prior to joining the
                 organization, she was the vice-president of Nursing, Allied Health,
                 Clinical Programs and Patient Safety at The Ottawa Hospital.
                 Her background includes experience in all levels of patient care, from
                 bedside through to senior management. In addition, Wendy has
                 been an Accreditation Canada Surveyor and board member (1996–
                 2002), including board Chair. She demonstrates her commitment
                 to improving the quality of healthcare for Canadians through her
                 involvement in a number of provincial and national boards such
                 as the Canadian Patient Safety Institute. Wendy is chair of the
                 Accreditation Council of the International Society for Quality in
                 Health Care (ISQua) and chair of the Accreditation Council Research
                 Working Group. Wendy has academic appointments to both Queen’s
                 University and the University of Ottawa.
                 Her education qualifications include a baccalaureate and master’s
                 degree from McGill University, certification as a healthcare executive
                 (CHE) with the Canadian College of Health Service Executives
                 (CCHSE), and a fellow of the American College of Healthcare
                 Executives (FACHE).

                 robert ouellet
                 canadian medical association
                 Dr. Robert Ouellet received his medical degree from the Faculty of
                 Medicine of the University of Montréal in 1970. Between 1971 and
                 1975, Dr. Ouellet trained at the University of Montréal, obtained his
                 certificate of specialty in diagnostic radiology, and became a fellow
                 of the Royal College of Physicians and Surgeons of Canada. He also
                 trained later in ultrasound, CT scan and MRI.
                 Dr. Ouellet began practicing medicine in 1975 in the Mauricie
                 region of Quebec. In 1978, he became the director of the Clinique
                 de radiology des Récollets in Trois-Rivières. He served in the
                 radiology department of the Cité de la Santé de Laval and of the
                 L.H.-Lafontaine Hospital in Montréal and at the Centre hospitalier
                 ambulatoire régional de Laval. He also lectured on the adequate and
                 optimal use of radiologic technology. In 1985, he was promoted to
                 head of the radiology department of the Cité de la Santé de Laval.
                 Dr. Ouellet is currently continuing his radiology and management
                 work at the five clinics he runs, and provides radiology services at
                 the L.H.-Lafontaine Hospital. He has worked in both the public and
                 private sectors for close to 20 years.

22   | Metrics for HealtHcare Quality: tHe leader’s role |
           micheline ste-marie
           associate director of Professional services
           montreal children’s hospital of the mcGill university health centre
           Dr. Ste-Marie, a physician executive leader, is associate director of
           professional services at the Montreal Children’s Hospital, part of the
           McGill University Health Centre (MUHC) and associate professor,
           department of pediatrics, Faculty of Medicine, McGill University. Dr.
           Ste-Marie previously held positions at the IWK Hospital for Children
           in Halifax, Nova Scotia, and was associate dean for undergraduate
           studies and student affairs in the Faculty of Medicine at Dalhousie
           University, Nova Scotia. She often leads collaborative work on
           provincial and national patient safety initiatives.
           Dr. Ste-Marie chairs the Groupe Vigilance pour la sécurité des soins.
           Composed of experts in all fields of healthcare and safety, the Groupe
           is a permanent consultative body to the Quebec Minister of Health
           and Social Services. Dr. Ste-Marie has leadership roles in inter-
           professional workgroups mandated to implement improvements
           in clinical practice, and is also involved in work dealing with new
           inter-professional education models. She is a fellow of the EXTRA
           (Executive Training for Research Application) program. She is also
           actively involved in several community groups; in that capacity, she is
           a member of the board of directors of Opération Enfant Soleil and The
           Lighthouse, Children and Families.

           terrence sullivan
           chief executive officer
           cancer care ontario
           Dr. Sullivan is President and Chief Executive Officer of Cancer
           Care Ontario. He joined the provincial cancer agency in 2001 and
           occupied successively more responsible positions in preventive
           oncology/research. From 1993 to 2001, Dr. Sullivan held the position
           of president of the Institute for Work & Health (IWH), a private
           not-for-profit institute affiliated with the University of Toronto,
           which he developed into North America’s leading research centre on
           work-related injury. Dr. Sullivan has held senior roles in the Ontario
           ministries of Health, Intergovernmental Affairs and Cabinet Office.
           He served two successive First Ministers of Ontario as executive
           director of the Premier’s Council on Health Strategy, including a
           period of time as Deputy Minister.
           Dr. Sullivan is an active behavioural scientist with research
           and practice interests in cancer prevention and health-system
           performance. He holds faculty appointments in the Departments
           of Health Policy, Management and Evaluation and the Dala Lana
           School of Public Health at the University of Toronto. Among his
           voluntary commitments, he is vice-chair of the Ontario Agency for
           Health Protection and Promotion and he chairs the Performance
           Committee of the Canadian Partnership Against Cancer.

Metrics for HealtHcare Quality: tHe leader’s role |                  23
speaker biographies
                 robyn tamblyn
                 Professor, department of medicine and department of
                 epidemiology and Biostatistics
                 mcGill university, Faculty of medicine
                 Dr. Robyn Tamblyn is a professor in the Department of Medicine
                 and the Department of Epidemiology and Biostatistics at McGill
                 University, Faculty of Medicine. She is a James McGill Chair and she
                 also holds a position as medical scientist at the McGill University
                 Health Centre Research Institute. Dr. Tamblyn heads a CIHR-funded
                 team to investigate the use of e-health technologies to support
                 integrated care for chronic disease. She leads initiatives to optimize
                 drug management and enhance the early uptake of evidence
                 into primary care practice, the Medical Office of the 21st Century
                 (MOXXI). She has received the CHSRF Knowledge Translation Award
                 for her research in improving the use of medication, as well as the
                 ACFAS Bombardier Award for innovation in the development of
                 the computerized drug-management system. She is also scientific
                 director of the Clinical and Health Informatics Research Group at
                 McGill University.

                 oliver j. warren
                 surgical registrar, london, and core member of the National
                 leadership council
                 National health service, u.K.
                 Dr. Oliver Warren is a specialist registrar in general surgery in North
                 West London. In spring 2009, he was appointed to the emerging
                 leader role on the NHS National Leadership Council. During 2008,
                 Oliver worked in the Department of Health as a clinical policy
                 advisor to Professor Lord Ara Darzi and the Next Stage Review
                 team, where he was involved with the leadership and workforce,
                 education and training workstreams and led on the engagement
                 of junior doctors. In 2008, Oliver established “Prepare to Lead,” a
                 leadership development mentoring program for London’s aspiring
                 medical leaders. He continues to lead the scheme into its third year.
                 Oliver is a clinical advisor to the senior management team of NHS
                 London Strategic Health Authority and in 2007 worked as surgical
                 advisor to the local hospital project for Healthcare for London. From
                 2007 to 2009 he was a leadership fellow at the Health Foundation.
                 This year he completed his doctorate, and has published over 30
                 peer-reviewed scientific papers and four book chapters on subjects
                 including haemorrhage and inflammation in cardiac surgery, surgical
                 education, and training, mentoring and leadership development.

24   | Metrics for HealtHcare Quality: tHe leader’s role |

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