Use this step by step workbook to guide you through a quality improvement project and help you to think about your particular contexts, ensuring that you undertake measured improvement and that you consider what you need to know. (Follows this paper on quality improvement in healthcare).

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence)
Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

A valuable resource for front-line physicians and health care workers.

• See video for High Risk Covid-19 Patients >
• Original Serious Illness Conversation Guide video here – for Acute Medicine & Surgery
• Accompanying POCKET GUIDE can be downloaded here>
• A message from Dr. Ruth MacRedmond

This document examines the benefits of value-based investments, explores value-based funding models and procurement, and draws on Canadian and global experiences to build capacity for value-based healthcare transformations.

Canadian Society of Physician Leaders White Paper

The purpose of this white paper is to stimulate dialogue and action: to facilitate the development of an environment that will create the energy and commitment needed for physicians to take charge of their own future — on their own and in collaboration with their partners in the health care system.

Browse the PHC Learning and Quality Resource Centre for:

• PHC QI Challenge updates
• PHC Improvement Team contacts
• Framework for QI Projects at PHC
• Courses and Skills
• Personal Development

The SSC is a Doctors of BC and BC Government collaborative partnership that supports BC-based Specialist Physicians with a number of programs to develop physician capacity. These include:

The Physician Leadership Scholarship: Funding for physicians as certificants or fellows of the Royal College of Physicians and Surgeons of Canada who are actively and independently practicing in BC. Scholarship funding is available for course fees.

UBC Sauder Physician Leadership Program

The “go to” organization for physician leaders.

Provides support and development opportunities for Canadian physicians to help them succeed in their leadership and management roles in health care.

Forums for education and networking, to expose physician leaders to quality leadership development programs and to provide membership-valued tools.

A great resource for any physician considering or working in a leadership position at all levels of the Canadian health system.

Annual Canadian event that brings together new and seasoned leaders for learning and inspiration. Recommended by Providence physicians.

The Leading at Providence program provides learning for:

• emerging/new leaders in front line supervisory roles;
• those aspiring to be leaders, who are supported by their supervisor/manager;
• leaders with two to five years’ experience &/or those who are new to operational leadership roles at PHC

Registration is accessible online through the Learning Hub at: http://learninghub.phsa.ca/Learner/Home

Going into its 15th learning cohort in 2021, Providence Physicians who have participated in the past have spoken highly of the value of both the networking and learning.  Applications are accepted from PHC physicians in current leadership positions or those with prior leadership experience.

Expressions of interest should be sent to alevelt@providencehealth.bc.ca

Aspiring leaders are encouraged to look at courses offered by Joule, the learning subsidiary of the Canadian Medical Association.

A full course catalogue can be found here: https://joulecma.ca/learn  

Classroom and on-line learning courses include: Leading Change, Dollars and Sense, Effective Communications and Engaging Others.

A series of distinct webinars, each one highlighting important learning that has emerged from a quality perspective during the health care response to the pandemic. The series aims to mobilize critical knowledge and enhance the understanding of the new normal moving forward.

Helps innovators in B.C. access funding, launch their ideas and connect with the experts they need to build companies.  Includes up to $10,000 a year for new tech startups to hire a student for a new tech role.  Scope includes:

Programs to help technology start-ups grow and create jobs in B.C.

A spectrum of business development and partnership opportunities.

Support B.C. entrepreneurs and companies at all stages of growth, offering tools, resources and expert guidance.

Builds the capacity of B.C. companies to access global markets and attract new investment.

Curates and facilitates strong relationships between industry and B.C. public post-secondary institutions.

Provides policy and program advice to government to foster innovation.

Works with regional partners to ensure the benefits of technology and innovation are felt around the province.

Shared Care involves redesigning collaboration between specialists and family physicians to improve the interface, communication, and relationships between physicians and patients, with the goal to streamline the patient journey as they transition between areas of care.

Depending on the clinical gap identified, teams work to develop, implement, evaluate and spread successful prototypes with the intent to: foster mutual trust and respect, improve collaboration, cultivate collegial relationships, and bridge gaps in care to improve health and patient/provider experience.

For Shared Care initiatives at Providence, contact Margot Wilson at mwilson@providencehealth.bc.ca

A landmark Mayo Clinic study reveals that organizational-driven efforts which address workplace drivers of provider burnout (e.g. work flow, efficiency, technology) and provide opportunity for self-care – can reduce burnout and promote engagement.  Read more >

Summarizes 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic.

The Mayo experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference.

Proven methods for creating a positive work environment that addresses burnout, and creates conditions to support the commitment of providers to deliver high-quality care to patients, even in stressful times.

IHI is partnering with experts around the world to offer new thinking and resources, including principles and techniques that enable the workforce to truly thrive, not just persevere.

Doctors of BC Physician Health Program

People interested in advancing and fostering innovation meet to discuss new technological trends and their potential application in health care, business, society and the environment.

This is a multidisciplinary forum where, collectively, will be uncovering how new technologies are altering the way we work and live today and how these trends will shape our future.

An international non-profit competition and accelerator for medical device, digital health and diagnostic companies that are transforming the healthcare system.

Offers accelerator and funding opportunities.

A newer international program that offers some great resources and support on their website to help startups and innovators build businesses.

Plug and Play is a distributed innovation support program with lots of good resources and connections.

A Canadian Government program called the “Canadian Technology Accelerator” initiative helps Canadian companies with an existing technology, product or service explore opportunities in foreign markets.

The Medical Device Development Centre (MDDC) is a non-profit British Columbia society whose mandate is to advance the collaborative development, evaluation and commercialization of need-oriented medical technology.

Hosts an incubator program for device and technology development in Vancouver in a collaborative environment for medical technology innovators.

A Canadian Government program that has accelerator style support and some funding opportunities. It offers a comprehensive suite of programs to help innovators in health care move from concept to commercialization.

Funded by the Government of Canada, empowers people with bold ideas for big impact.  Includes funding opportunities for work being done in high-need settings.

Techstars Foundation works to make innovation and entrepreneurship more accessible and inclusive by investing in and accelerating nonprofits that deliver scalable impact for underestimated entrepreneurs.

Telus is pivoting into digital health space and provides a venture support program:

Strategically invests in the most advanced and innovative solutions that have the potential to drive significant growth, impact and scale and are strategically aligned to the broader TELUS mandate.

One of Canada’s most active corporate venture capital funds. Since 2001, we’ve invested and helped more than 70 market transforming companies tackle some of today’s biggest challenges by enhancing their visibility, expanding their business relationships, and driving new business opportunities.

Canada’s largest research and treatment facility at St. Paul’s.

Scientists examine Vancouver’s marginalized populations:

A group of experienced health outcomes researchers based at St. Paul’s Hospital evaluate the effectiveness of health interventions in populations to understand how to improve health and transform health systems for the future.

Virtual Health options and supports for physicians and health care providers working at Providence.

The SSC is a Doctors of BC and BC Government collaborative partnership that supports BC-based Specialist Physicians with a number of programs including the highly regarded Physician Quality Improvement (PQI) Initiative.

PQI provides training and support to physicians, through technical resources and expertise to lead quality improvement (QI) projects which build QI capacity, increases physician involvement in QI, and aims to enhance the delivery of quality patient care.

Praxis exists to lead global collaboration in spinal cord injury research, innovation and care, using  SCI knowledge translation to bridge health evidence with real-world delivery.

A nonprofit organization that delivers an objectives-based program for massively scalable, seed-stage, science- and technology-based companies.

Mentorship from select entrepreneurs and angel investors: Intensive full-day sessions every 8 weeks to assess progress and set new short-term objectives.

Opportunities to raise capital: Meetings with a group of exited entrepreneurs, angel investors, and partners from leading venture capital firms.

Advice on technology roadmaps from CDL’s Chief Scientists: World-renowned experts from leading academic institutions provide technical feedback to founders and advise on objectives related to technology validation.

Business development support from top MBA students: MBA students work with founders to develop financial models, evaluate potential markets, and fine-tune strategies for scaling.

Simon Fraser University’s innovation strategy with a mission to engage SFU researchers, staff and students with communities and partners to solve societal challenges through innovation and entrepreneurship. Its four pillars include:

Entrepreneurship – Developing a mindset that applies creativity, adaptability and collaboration to solve problems that matter.

Social innovation – Developing emerging leaders and solutions for a sustainable, just and healthy community.

Incubation and acceleration – Transforming ideas made in the classroom, lab and community into ventures that scale.

Industry and community research partnerships – Bridging the gap to create innovations that benefit society.

All clinical faculty of UBC are eligible.

CORE Venture Building works with entrepreneurs who are building solutions founded in tech and innovation, helping to develop their startup through practical business training and deep mentorship.

Incubates over 100 ventures annually, producing skilled entrepreneurs with validated business models.

The incubator phase helps UBC founders to execute on their ideas by intensely focusing on customer discovery, competitive analysis, problem validation and product-market fit.

Ventures go through one of our foundational programs, Lab2Launch or CORE.

Ventures can be in the incubation phase anywhere from 5 weeks to several years, culminating with an opportunity to apply to the HATCH Accelerator program.

One of the longest serving angel networks in Canada, and a community for new or seasoned investors with resources, knowledge, and opportunities.

Connects promising start-ups with accredited angel capital from all over British Columbia, Canada and even the US.

Offers workshops to both entrepreneurs and investors.

Introduces early-stage investors to promising technology ventures in British Columbia.

Genome BC invests in research that aligns with the needs of areas of strategic importance to British Columbia such as health, forestry, fisheries and aquaculture, agrifood, energy, mining and environment.

The co-funding approach to research investment follows neither a government-only “granting council” model, nor an industry-only “portfolio management” approach. It is a unique approach that relies on collaborative research agreements and commitments to milestones and outputs, a model perhaps best described as “contract” research.

Funds research across the research continuum from discovery through application through translation.

 Idea to Innovation (I2I) grants accelerate the pre-competitive development of promising technology originating from the university and college sector, and promote its transfer to a new or established Canadian company.

Provides funding to college and university faculty members to support research and development projects with recognized technology transfer potential. This is achieved through defined phases by providing crucial assistance in the early stages of technology validation and market connection.

Four distinct funding options are characterized by the maturity of the technology or the involvement of an early-stage investment entity or an industrial partner. In the market assessment, NSERC will share costs of an independent and professional market study with the institutions (including the industry liaison office [ILO] or its equivalent).

Eligible research and development activities include (but are not limited to):

• refining and implementing designs;
• verifying application;
• conducting field studies;
• preparing demonstrations;
• building prototypes; and
• performing beta trials.

Provides funding for projects — up to 55% — and connect highly trained researchers with the businesses that need them and help guide you through the process.

Connects industry with the best post-secondary institutions to solve business challenges in Canada and internationally.

The National Research Council of Canada Industrial Research Assistance Program (NRC IRAP) provides advice, connections, and financial support to help Canadian small and medium-sized businesses increase their innovation capacity and take ideas to market.

From funding to expert advice: 

Backing possibilities through programs like the Innovative Superclusters Initiative.

The Strategic Innovation Fund  invests in innovative businesses—helping them scale-up, research, develop and commercialize cutting-edge ideas and collaborate in new ways.

Innovative Solutions Canada,: a program dedicated to Canadian innovators who want to start, grow, and get to market, by funding for R&D and testing prototypes in real-life settings.

ExploreIP:  marketplace for businesses looking to access intellectual property held by public sector institutions in Canada.

Clean Growth Hub gives entrepreneurs and businesses with clean technology projects guidance, opportunities to talk through options or introductions.

The Accelerated Growth Service gives high-growth companies one advisor for all of government – to knock on doors, pick up the phone and make the right connections.

MSFHR is BC’s health research funding agency. Funding programs are designed to attract, develop and retain BC’s health research talent and contribute to addressing BC health system priorities.

Individual funding programs

Health Professional-Investigator (HP-I) Program – Supports health professionals (e.g. MD, RN, PT) to develop and advance research with the goal of bringing research evidence into practice within the health system.

Health Policy Fellowship Program / Health System Impact Fellowship – Connects post-doctoral (PhD, MD) health researchers with health policy decision-makers and their projects to enhance understanding, communication and promote evidence-informed policy-making.

Innovation to Commercialization (I2C) Program – Supports researchers to advance their discoveries or inventions towards practical application, resulting in products or technologies that improve health outcomes and enrich BC’s health innovation ecosystem.

Research Trainee Program – Supports health researchers in the training phase of their research career to enable career development and the long-term success of the BC health research landscape.

Scholar Program – Supports early career health researchers, helping them form their own research teams, train the next generation of scientists and develop world-leading research programs.

Team funding programs (KT-focused)

Convening & Collaborating (C²) Program – Supports teams of health researchers and research users as they co-develop research aligned with BC’s health system priorities. These collaborations increase the likelihood that the research findings will be relevant to users.

Implementation Science Team Program – Supports teams to plan, conduct, and study the implementation of proven health-related interventions that address one or more of BC’s current health system priorities.

Reach Program – Supports teams of researchers and research users to disseminate research evidence, within the context of related knowledge, to facilitate its effective uptake and potential to impact health and care.

Graduate Certificate in Science & Technology Commercialization -Invention to Innovation (i2I) is a unique and rewarding entrepreneurship program that helps scientists and engineers commercialize their inventions and overcome marketplace challenges.

The 11-month, part-time program also provides start-up ventures or existing firms with essential frameworks, perspectives and techniques to contribute to new product development and commercialization in industry.

Mentors can help move your venture forward:  competition provides our startup participants with personalized mentorship and professional feedback from leading industry experts.

Have an early-stage business?  Validate your opportunity with the Online Market Validation Training program (MVT).

Canada’s Wage Subsidy programs that provide financial support to bio-economy employers, with the goal to reduce the risk of hiring talent.

Finds and promotes promising innovators and innovations that respond to healthcare priorities.

Spreads and scales proven innovations: including to lead partnerships to expand the reach of proven practices, policies and programs.

Enhances capacity and capability for improvement: supports teams to learn, share and improve together, develop skills and expertise needed for continuous improvement.

Connects and supports healthcare leaders from across Canada to share policy insights, identify ways to advance collective change, and accelerate the transformation of our health systems.

Here to help BC tech startups: Through government and corporate support, Venture BC programs provide the education, tools, networking, and funding you need to succeed.

A great resource to identify your key partners, activities, value proposition and customer relationships and channels.

Note: This link downloads a PDF.

Free Course. Medical Staff may opt to pay a modest fee to obtain a certificate.

Indigenous Canada is a 12-lesson Massive Open Online Course (MOOC) from the Faculty of Native Studies that explores Indigenous histories and contemporary issues in Canada.

From an Indigenous perspective, this course explores key issues facing Indigenous peoples today from a historical and critical perspective highlighting national and local Indigenous-settler relations.

Topics for the 12 lessons include: fur trade and other exchange relationships, land claims and environmental impacts, legal systems and rights, political conflicts and alliances, Indigenous political activism, and contemporary Indigenous life, art and its expressions.

Canada’s Digital Technology Supercluster (CDTS)  is a unique transformative opportunity to partner with industry to design, develop and accelerate innovative solutions that improve the lives of British Columbians.  Providence Health Care, supported by the St. Paul’s Foundation, is a founding member of the Supercluster.

CMPA Physician Wellness provides resources for physicians beyond medical-legal assistance and provides advisory services in addressing physician stress.

Established in 2016 by professors Elizabeth Teisberg, PhD, and Scott Wallace, JD, MBA, the Value Institute for Health and Care is the nexus for thought leadership and community implementation of high-value care.

A value based health care approach: A framework and programs.

Academy of Medical Royal Colleges and NHS Confederation 2014 Report explores a culture shift in healthcare towards better value.

Note: Click the link to download a PDF.

Recommended articles for an introduction to Value Based Health Care.

Porter ME. What is Value in Health Care?

Teisberg E, Wallace S. Creating a High Value Delivery System for Health Care

Stowell C, Akerman C. Better Value in Health Care Requires Focusing on Outcomes: Harvard Business Review

Porter ME. Measuring Health Outcomes: The Outcome Heirarchy

Advanced training available: M.Sc. in Health Care Transformation

Information and guidance to those who are interested in learning about VBHC; those who are thinking about implementing it; and those who are ready to assess and improve their current VBHC initiatives.

Some excellent recommended reading, annoted by PHC QSV Pillar physicians.

Fischhoff, B. (1975). Hindsight is not equal to foresight: The effect of outcome knowledge on judgment under uncertainty. Journal of Experimental Psychology: Human Perception and Performance, 1(3), 288–299.   The classic paper. Knowledge of outcome distorts our understanding of an event and contributes to overconfidence in our ability to predict outcomes of future events. This is the primary flaw in retrospective analyses of patient safety events. Read >

Paget MA. The unity of mistakes: a phenomenological interpretation of medical work. Temple University Press. 1988. An existential view of medical work in which things go wrong as an intrinsic part of clinical work and probes the “complex sorrow” that can result. Read >

Weick KE. The collapse of sensemaking in organizations: the Mann Gulch disaster. Administrative Science Quarterly. 1993;38(4):628-652. 10.2307/2393339 Read >

Rochlin G. Safe operations as a social construct. Ergonomics. 1999;42(11):1549-1560. 1 One of the very first papers I read on safety. Based on empirical work on organizations that manage complex, technically hazardous operations. Safety understood as a dynamic, interactive and intersubjective action that is “not readily measured in terms of safety culture…and particularly vulnerable to disruption or distortion by well-meant but imperfectly informed interventions aimed at eliminating or reducing ‘human error’ that do not take into account the importance of the processes by which the construction of safe operation is created and maintained.” Read >

Dekker SWA. Why doctors are more dangerous than gun owners: a rejoinder to error counting. Human Factors. 2007;49(2):177-184.  Read >

Woods DD, Dekker S, Cook R, Johannesen L, Sarter N. Behind human error, 2^nd Ed. 2010. CRC Press:London.  Essential reading. Goes behind ‘human error’ label.” Human error is cited over and over as a cause of incidents and accidents, and solutions are thought to lie in changing people or their role in the system. For example, we should reduce the human role with more automation, or regiment human behavior by stricter monitoring, rules or procedures. But in practice, things have proved not to be this simple. The label ‘human error’ is prejudicial and hides much more than it reveals about how a system functions or malfunctions.” Read >

Borys D, Else D, Leggett S. The fifth age of safety: the adaptive age. Journal of Health and Safety Research and Practice. 2009; 1(1): 19-27. Read >

Antonsen S. Safety culture assessment: a mission impossible. Journal of Contingencies and Crisis Management. 2009;17(4):242-254. Read>

Waring J. Constructing and re-constructing narratives of patient safety. Social Science and Medicine. 2009;69(12): 1722-1731. Read >

Hollnagel E. Coping with complexity: Past. present and future. Cognition, Technology & Work. 2012;14(3):199-205. Read >

Cook R, Rasmussen J. “Going solid”: a model of system dynamics and consequences for patient safety. Quality and Safety in Health Care. 2005;14:130-134. Read >

Mesman J. Resources of strength: an exnovation of hidden competences to preserve patient safety. In: A Socio-Cultural Perspective on Patient Safety. E. Rowley & J. Waring (eds.). 2012. Aldershot: Ashgate Publishing Ltd. Read >

Wears RL, Hunte GS. Seeing patient safety ‘Like a State’. Safety Science. 2014;67:50-57. Read >

Woods DD. Four concepts for resilience and the implications for the future of resilience engineering. Reliability Engineering and System Safety. 2015;141:5-9. Read>

Braithwaite J, Wears RL, Hollnagel E. Resilient health care: turning patient safety on its head. International Journal for Quality in Health Care. 2015;1-3. 10.1093/intqhc/mzv063  Read >

J Patient Saf 2015 Harrison R. Emotion and Coping in the Aftermath of Medical Error: A Cross-Country Exploration: This cross-sectional survey of 265 providers in teaching hospitals in the UK and USA describe the emotional response, coping strategies and perceptions of organizational support when a medical error has been made.

The Canadian Institute for Health Information (CIHI)’s  and the Canadian Patient Safety Institute (CPSI) have developed a new measure of harm occurring in Canadian hospitals. This is its national picture for 2016.

2016 CIHI Report Summary Measuring Patient Harm in Canadian Hospitals: This provides a summary of a report developed jointly by the CPSI and CIHI measuring harm in Canadian Hospitals and outlining the 31 types of harm captured in the measure.

JAMA 2013 Zimlichman et al. Health Care-Associated Infections: A Meta-Analysis of Costs and Financial Impact on the US Healthcare System: This meta-analysis estimates the costs associated with the most significant and targetable health care-associated infections. CLABSIs were found to be the most expensive, followed by VAPs, SSIs, CDIs and CAUTIs.

Botwinick L, Bisognano M, Haraden C 2006 Leadership Guide to Patient Safety: This IHI White Paper presents 8 steps for leaders to follow to achieve patient safety and high reliability in their organizations. It focuses on the acute care setting but the fundamental concepts can be applied to other healthcare settings.

The IHI is recognized as a leader in the improvement of health and healthcare globally. At this link you’ll find the following:

Patient Safety Essentials Toolkit

A Leadership Guide to Patient Safety

How-to guides for specific topics (e.g. adverse drug events, VAPs, SSIs) and

The IHI Open School Patient Safety Curriculum which is packed with hundreds of modules, videos and downloadable tools and resources.

This website provides some great resources as follows:

1) physician leaders interested in working more effectively with patient partners and their families to improve patient safety.

2) peer support programs for the psychological safety of healthcare providers.

3) checklists for a whole variety of patient safety-related topics such as delirium, falls, central line infections, retained foreign objects etc.

A journal that publishes high quality, peer-reviewed papers in QI.

Links to great QI papers and a great resource for how to get started with QI projects.

The Institute for Healthcare Improvement (IHI) link is a good resource for Quality and Value in healthcare. It has some great articles and resources for quality and value as well as some free virtual courses on value and quality.

Irfan A. Dhalla, Joshua Tepper. A good ‘broad strokes” paper on key actions at the health-system level that would improved quality of health care in Canada.

Health Quality Ontario’s System Quality Advisory Committee. A good quality primer with Canadian focus and some of the quality resources from B.C.

Note:  Clicking on the link will download a PDF

The IHI has many great courses and certifications in Quality and Safety.

Its Open Learning School has many great online courses that can be done at your own base with CME credits. There are great quality articles and they put on a large conference on healthcare improvement every December in Orlando, Florida. Anyone with an interest in healthcare improvement is recommended to go at least once (pending COVID).

Good resources from the UK for Quality and Value in health care, and advice and support on how to use quality improvement approaches and methodologies. They have many tools for helping to improve quality of care. They also provide a variety of self-audit tools to assess a baseline for improvement.

NHS: Quality Improvement Hub

BMJ: How to get started in Quality Improvement

Search the provincial Exchange Database to see what other physicians are working on with funding from Specialist Services Committee PQI, Shared Care and Facility Engagement Initiatives.

This website has some very useful resources and spans all areas of healthcare.

What is quality?
This is a link to the newest version of BC’s Quality Health Matrix, a shared definition of quality for BC’s health care system.

Events
Upcoming webinars or conferences with a safety/quality focus.

Quality Cafe – Lunch Series
Quality Cafe is a free one-hour lunch and learn series that takes place on the third Wednesday of every month at 1200 PST.  Each features a new guest and topic related to improving quality of care.

This is a three part paper that is a “primer” on quality, and although it focuses on the Emergency Department, the concepts are relevant across the board, using a case study to illustrate.

Download in PDF:

PART 1: Preparing for a quality improvement project in the emergency department

PART 2: Executing a quality improvement project in the emergency department

PART 3: Evaluating and sustaining a quality improvement project in the emergency department

Chartier, L B.Canadian Journal of Emergency Medicine, PART 1: Jan. 2018, PART 2: July 2018, Part 3: Mar2019.

This 20 minute Ted Talk by Toronto ER doc (Brian Goldman, MD) speaks to the mental toll that making errors can have on physicians and urges doctors to start talking about making mistakes.

Three and 5 day Health Care courses suitable for physicians interested in Value Based Health , administrators, private industry, academic and government institutions.  On-line applications open a few months prior.

VBHCD Intensive Seminars – Institute For Strategy And Competitiveness – Harvard Business School (hbs.edu) 

Advanced Training: Harvard, 9 month Certificate >

NEJM 2020 Gandhi TK et al: This recent NEJM article describes how a systems-focused approach is vital to improving patient safety and outlines the 4 interdependent elements required including patient engagement, the creation and sustainment of a culture of safety, the development of an optimal learning system and the effective management of change.