Presentation to The Standing Committee on Justice Policy Bill 46: An Act Respecting the Care Provided By Health Care Organizations Dr. Robert Bell, President and CEO University Health Network Karen Michell Executive Director CAHO Thursday, May 20, 2010 Check against delivery
Good afternoon and thank you for the opportunity to present today on the hearings for Bill 46 – The Excellent Care for All Act. My name is Bob Bell and I am the President and CEO of University Health Network and a member of the Executive for the Council of Academic Hospitals of Ontario (CAHO). With me today is Karen Michell, the Executive Director of CAHO. Overview of CAHO As some of you may know, the Council of Academic Hospitals of Ontario is the association of Ontario’s 25 academic hospitals and their research institutes. CAHO provides a focal point for strategic initiatives on behalf of our member hospitals. As research intensive hospitals, CAHO members are fully affiliated with a university medical or health sciences faculty. Our hospitals provide the most complex and urgent care to the sickest patients in Ontario, teach the next generation of health care providers and foster health care innovation derived from discovery research. These discoveries include the development of the first artificial kidney machine, identification of a critical gene that causes colon cancer, and the development of digital mammography and MRI screening for early detection of breast cancer in young women. Such discoveries have led to widespread improvements in ensuring healthier and longer lives for Ontarians. From research in the lab to real-life experience at the bedside, CAHO hospitals focus on improving the delivery of care and developing new and better ways to treat patients and CAHO Presentation to Standing Committee on Justice Policy 2 May 20, 2010
cure disease. A 2008 national report attributed 77 percent of Canadian medical breakthroughs to Ontario research hospitals. Ensuring that all Ontarians continue to benefit from the discoveries of our CAHO hospitals, we need to make certain that Ontario remains a leader in harnessing this health research and innovation. CAHO will vigorously pursue the aspiration of making Ontario the premier health enterprise in the world. By supporting an environment that produces evidence-based world-leading health research and innovations, patients will continue to benefit from the discoveries of CAHO hospitals. This will in turn drive quality improvement for both patients as well as the health care system. Outline of Presentation It is for this reason that we are pleased to see the Ontario Government move forward with legislation that sets a framework to enable evidence and best practice to drive quality improvement which will ultimately lead to a more accessible, safe and sustainable health care system for all Ontarians. With our time today, we would like to focus our remarks on three key areas of discussion. 1. Leading by Example: Most of our research hospitals already have in place many of the initiatives the Government is proposing in this legislation. The Government needs to leverage the leadership and experience that already exists in the health care system to achieve their objectives of this legislation. CAHO Presentation to Standing Committee on Justice Policy 3 May 20, 2010
2. One Size Does Not Fit All: As the Government moves forward with the development of regulations and guidelines prescribed in the legislation, we need recognize the fact that all hospitals in Ontario are not the same and regulations and guidelines need to be developed with that in mind. 3. Getting it Right Through Collaboration. As many of the members of the legislature pointed out during the debate in the house on this Bill, the devil is in the details. We are encouraged that the government intends to work collaboratively with all partners to ensure that the spirit of the legislation is honoured, while creation a practice process for implementation. Leading by Example Research hospitals are already doing much of what the Government is trying to achieve with this legislation. CAHO hospitals have been at the forefront of efforts to drive quality improvement in health care for some time. For instance, at my own hospital here in Toronto, we have had a Quality of Care Committee (QCC) established for quite some time. This committee is tasked with ensuring quality patient care and a safe environment for patients, visitors and staff. The multi-disciplinary committee meets a minimum of ten times a year and provides quarterly updates to the Board. And I know we are not alone. Many CAHO hospitals have a similar model. In addition, UHN has a Quality Committee of the Board because the Public Hospitals Act deems the volunteer board accountable for the care delivered in the hospital. The CAHO Presentation to Standing Committee on Justice Policy 4 May 20, 2010
purpose of this committee is to review the quality of patient care and service delivery at UHN and make recommendation so the Board as required by monitoring key indicators of organization performance. This committee meets at least nine times a year and provides an annual report to the Board that summarizes relevant quality of care and service issues that arise. This Committee also employs an annual performance improvement plan with measureable goals. So, our hospital, as with many others in the province, already have executive compensation tied to performance objectives. Many research hospitals also have very extensive patient relations processes. The Ottawa Hospital for example has a Patient Advocacy and Clinical Risk Management Program. This program is designed to address the concerns that patients and their families have about the care they receive. But it doesn't stop there. Ottawa's program systematically uses these interactions with patients to learn how to make hospital care better for all patients. And this is by no means an exhaustive list. My peers within CAHO have also implemented many similar initiatives within their own hospitals. We undertook these initiatives not because we were required to do so; rather, as research hospitals it is engrained within our culture to strive for continuous improvement. We do this because it provides better care. As research hospitals, we use evidence and best practice to drive quality improvement which will ultimately lead to a more accessible, safe and sustainable health care system for all. CAHO Presentation to Standing Committee on Justice Policy 5 May 20, 2010
One Size Does Not Fit All It is worth noting that Ontario’s research hospitals are world-class. We compete on a global scale for research partnerships, top clinical and research talent, and investments. We have a unique role in our health care system. The mandate of a research hospital includes providing the most complex and resource intensive patient care in the health care system. This includes 100 percent of organ transplants and 83 percent of neurosurgeries, to name but a very few examples. In addition, 80 percent of health research in Ontario takes place in academic health sciences centres; the balance occurs at universities. i As the fourth largest biomedical research centre in North America, Ontario employs 10,000 researchers in a variety of disciplines across its research hospitals. This is an outstanding place to be when our economic future is tied to knowledge and innovation. CAHO hospitals serve all Ontarians. Regardless of what community a patient lives in and what local health integration network the research hospital is located within, we serve patients from all across the province. As the Government develops regulations and guidelines as prescribed in this legislation, we caution the Government against “one size fits all” changes that don’t make sense to all hospitals. For instance, our colleagues who operate rural hospitals have very different issues and challenges than we have at our research hospitals. Research hospitals should have different metrics for performance than community hospitals, reflecting the different roles we play in the system. For example, our CAHO Presentation to Standing Committee on Justice Policy 6 May 20, 2010
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