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CQuIPS Fellowship creates learning community

2021-22 Fellows. Top left to right: Katrina Piggott, Genevieve Bouchard-Fortier, Allison Brown, Natasha Gakhal. Bottom left to right: Beth Gamulka, Ashraf Kharrat, Sam Vaillancourt, Jennifer Wong.

Not everyone speaks the language of quality improvement (QI). This can make it difficult for people committed to QI work to find the mentorship needed to advance this work and pursue an improvement agenda in their organization. The Centre for Quality Improvement and Patient Safety (CQuIPS), whose purpose is to support and connect those working in QI, created a fellowship for exactly this reason: to bring people together with the ultimate goal of improving healthcare practices and outcomes.

“Although an individual might have formal training in QI, moving that knowledge into practice can be challenging,” said Joanne Goldman, CQuIPS scientist and Fellowship Director. “The CQuIPS Fellowship was established out of our goal to create a community for those who have been trained in QI and have dedicated time to do QI at their institutions, but are looking for continued learning and networking to strengthen their QI activities. The connections among and between the Fellows and CQuIPS have the possibility to lead to incredible results at organizations and the spread of impactful projects across our healthcare system.”

The Fellowship, now recruiting its next cohort for 2022-23, provides a myriad of resources for participants: a monthly learning session, an experienced QI mentor Fellows connect with regularly one-on-one, discussions and feedback on QI projects and opportunities to get involved at CQuIPS.

Jennifer Wong, a speech-language pathologist at Sunnybrook and one of the inaugural Fellows, said the connection with other fellows has been particularly rewarding.

“It’s amazing being part of a community of people who have a similar mindset about improvement and safety and who speak the same language,” she said. “It’s felt like all of our interactions – both with other Fellows and the facilitators – have come from a genuine place of connection and that’s been really meaningful to me.”

For Sam Vaillancourt, emergency physician and director of quality improvement for the emergency department at St. Michael’s, Unity Health Toronto and another inaugural Fellow, the education opportunity – from CQuIPS and his peer Fellows – has been a highlight.

“Even though I’m a little bit later in my career, I thought this might be interesting to go back to learning which, as you get further away from residency and everything, sometimes it can feel like the space for learning is gone,” he said. “A lot of people in our cohort have a fair bit of experience and have shared applied tips, difficulties and rewards. There’s a depth of engagement that I was hoping for and that turned out to be there which is really great.”

During their Fellowship, Wong and Vaillancourt have regularly shared updates on their projects with the other Fellows and their mentors. Wong’s main focus during the Fellowship has been on implementing a peer-to-peer vaccine champion program to support increased staff COVID vaccination rates at Sunnybrook.

“It’s been really helpful bouncing ideas off of Amanda,” she said of her mentor, Dr. Amanda Mayo, CQuIPS associate director for Sunnybrook. “And getting feedback from the other Fellows has been great too because we’re such a diverse group with different clinical and training backgrounds so that breeds opportunities for seeing things in new ways.”

Vaillancourt was paired with Patricia Trbovich, CQuIPS research and scholarship lead, who has supported him through his work on a patient-reported outcome measure questionnaire for patients leaving the emergency department.

“My mentor is quite exceptional,” he said. “It’s been really great to have some time with her every month and be able to share experiences, stories and difficulties as I’ve worked through this project.”

Fellows have had a significant role at CQuIPS: they supported the design, creation and launch of the virtual learning platform CQUIPS+ that now has almost 300 members; they’ve taken on leadership and teaching roles with our education programs; and they’ve collaborated with CQuIPS and its external partners including Choosing Wisely Canada and Canadian Blood Services.

“We’ve benefited from having these Fellows as part of the CQuIPS team just as much as they’ve benefited from being part of the Fellow group,” said Goldman. “We had such an incredible group for our first cohort – they’ve helped co-create this Fellowship to help make it the best possible experience for all future Fellows.”

Want to be a CQuIPS fellow? We are accepting applications for our second cohort until March 21 – learn more about eligibility and how to apply.

Where stewardship meets safety

Dr. Olivia Ostrow is a leading voice in Canada on quality improvement (QI) related to stewardship and safety for children. Despite the challenges faced as a clinician working the frontlines in a pediatric emergency room over the last 18 months, the QI work Ostrow is currently involved in has actually expanded during the pandemic. She’s joked that due to the increased virtual nature of some of her work, she can be presenting to people in Ontario one minute and then in Texas the next. But it’s this cross-border work that has her most excited, as someone who was born in the United States and spent a large part of her early career practicing there.

Here is just a snapshot of what Ostrow, staff physician and patient safety lead for the Division of Pediatric Emergency Medicine at the Hospital for Sick Children (SickKids) and the associate director for SickKids at CQuIPS, has on the go.

American Academy of Pediatrics
SickKids is just one of two Canadian sites (Ostrow also encouraged BC Children’s Hospital to join) in the American Academy of Pediatrics Value in Inpatient Pediatrics (VIP) QI collaborative that aims to reduce overutilization and unnecessary care in hospitalized children. Ostrow is currently a member of an expert working group on a utilization initiative related to bronchiolitis, a common disease in young children during the winter viral season. Because SickKids is also actively participating in the study, Ostrow is coaching her site as well as others in the United States on QI methodology and concepts. In November, she was a featured presenter on QI topics for all 90 participating hospitals. “It’s been a rewarding opportunity to be part of a North American QI collaborative and share some of my expertise,” she said.

Choosing Wisely
Ostrow is the associate director for SickKids’ Choosing Wisely program, and, nationally, the pediatric lead for the Using Antibiotics Wisely Campaign with Choosing Wisely Canada. Now, she’s turning her attention to supporting the creation of a list for pediatric emergency medicine, which will likely be Choosing Wisely’s first cross-border list for children. Part of the challenge for Ostrow and the team of pediatric emergency physicians in the US she’s working with is trying to narrow down recommendations to just five, and avoid overlap with other existing society lists. “It’s going to take several months, but we’re very excited,” she said. “It’s been a valuable learning experience and opportunity to collaborate with colleagues south of the border who are passionate about this work. By joining forces, we hope to create a bigger impact for children.” 

Community of practice
Together with Dr. Jeremy Friedman, associate paediatrician-in-chief at SickKids and the director of SickKids’ Choosing Wisely program, Ostrow has also helped establish a Canadian-wide community of practice to engage clinicians who are interested in resource stewardship for pediatrics. The group meets a few times a year to share stewardship opportunities, network and collaborate. “Our community includes almost all of the provinces – we’re getting there,” she said.

Pediatric emergency medicine
Ostrow was asked this fall to present at SickKids’ Pediatric Emergency Medicine Conference on safety issues she’s seen trend over the last year, partially through her roles as a medical safety leader at SickKids and as co-chair of the provincial Emergency Department Return Visit Program. She discussed opportunities to leverage systems to make it easier to flag abnormalities to healthcare providers such as abnormal vital signs which are very different in children than adults. At SickKids, there’s a built-in electronic double check for clinicians at discharge – any child with abnormal vital signs or who has not had vital signs checked within four hours is flagged as a last opportunity for clinicians in a busy emergency room to pause and confirm the child is safe to be sent home.

In her talk, Ostrow also focused on critical response time in addressing children who have swallowed button batteries. She is part of a multidisciplinary working group at SickKids working to help equip SickKids and other hospitals across the GTA to prepare for this problem as it only takes two hours for these batteries to permanently harm a child. Her talk also acknowledged the current risks with many hospitals experiencing staffing shortages in addition to high patient volumes. “As a safety leader, I wanted to emphasize our strengths, which are our colleagues, our system-level interventions and safety culture so that safety continues to be prioritized during these challenging times,” she said.

A passion for stewardship and safety
Ostrow’s work is in two distinct fields – stewardship and safety – that she says are far more connected than some may realize.

“While one might say that most over-testing and treatments doesn’t cause harm – maybe just a hassle –unintended consequences do occur, but are less often thought of and often more challenging to measure. For example, every time a child is referred for an unnecessary MRI or to see a specialist that doesn’t really need it, not only does that lead to time away from work and other challenges for families, but another child who really needs that care is potentially bumped and having to wait that much longer,” she said. “And how we treat children in healthcare now impacts the rest of their lives. For instance, if children receive antibiotics unnecessarily now, it makes them more prone to developing antimicrobial resistance, a current top global health threat.”

Ostrow has several upcoming talks on building safety cultures and QI. She will also be leading a CQUIPS+ QI primer on PDSA cycles in April.

“I consider myself a hands-on improvement specialist and my heart lies in solving frontline problems in healthcare,” she said. “I feel fortunate to have the opportunities to do that.”

Call for applications: CQuIPS Education Lead

The Centre for Quality Improvement and Patient Safety (CQuIPS) is currently looking for an Education Lead to play a key role in the development, organization and scholarship of its education programs. This individual will have a leadership role while working collaboratively with CQuIPS team members including CQuIPS director, course directors, education coordinators and education researcher. The time commitment is 0.1 FTE.

CQuIPS is an extra-departmental unit of the University of Toronto Temerty Faculty of Medicine, supported jointly by Sunnybrook Health Sciences Centre, The Hospital for Sick Children and Women’s College Hospital. CQuIPS has an international reputation as a leading centre in building capacity among healthcare providers and leaders to implement change at a health-system level to improve the quality of care that patients and families experience. The CQuIPS strategic plan for 2020-2024 lists learning as one of its three domains of work, with the other two being scholarship and networking. CQuIPS currently delivers two longitudinal QI education courses for healthcare providers, a Co-Learning QI program for physician trainees, and a Fellowship course for healthcare providers and QI researchers. The Centre also supports the Veterans Affairs Quality Scholars program in Toronto and has partnerships with the IHPME Masters QIPS program.

The Education Lead will oversee the Centre’s education activities. This will involve working with course directors on curriculum development and evaluation and the education researcher on education research. The Education Lead will strive to harmonize best education practices across CQuIPS education programs, work towards the Centre’s key themes of health system resilience and health equity through learner recruitment, faculty development and education programming, and support education scholarship.

The successful candidate will receive an annual stipend to support this work. The position is for a 3-year term with the opportunity to renew and will require a commitment of 0.1 FTE.

Duties and responsibilities:

  • Provide oversight across CQuIPS education programs
  • Responsible for high level education strategic planning and proposing education innovations to evolve and improve CQuIPS education programs
  • Support research and scholarship of education programs
  • Promote the use of education theory to enhance curricular elements across education programs (e.g., in pursuit of theme of equity)
  • Support course directors and education coordinators to implement processes to increase diversity of course faculty and coaches, and ensure equitable and inclusive learner recruitment and selection processes
  • Teach and coach as part of one or more of the CQuIPS education programs
  • Advise CQuIPS Director on the recruitment and selection of course directors
  • Work closely with course directors and coordinators to oversee course promotions and communications with support from CQuIPS communications lead
  • Engage with external organizations engaging in QIPS education
  • Attend weekly CQuIPS leadership team meetings and quarterly EDU meetings

Requirements:

  • Either advanced training in QIPS (e.g., certificate, MSc in QIPS etc.,) with strong interest in education or advanced training in education (e.g., certificate, MEd etc.,) with strong interest in QIPS
  • Demonstrated ability to effectively teach others on QIPS concepts and skills, ideally having taught learners at different stages of training and from different professional backgrounds
  • Experience leading or contributing to the design, implementation and/or evaluation of QIPS education programs
  • Strong organizational, analytical and problem solving skills
  • Strong interpersonal, communications skills and ability to successfully build relationships
  • Able to work independently and as part of a team

To apply for this position, please send the following to Leahora Rotteau, CQuIPS Program Manager, at leahora.rotteau@sunnybrook.ca by December 17 2021:

  1. A statement of interest; please address one of the following questions:
    • What is the future of QIPS education?
    • What are the biggest challenges facing QIPS education?
  2. A short CV (5 pages max.)
  3. An example of your QIPS education practice or research (e.g. publication, presentation, recorded talk)

Equity and diversity

CQuIPS, as part of the University, strives to be an equitable and inclusive community, and proactively seeks to increase diversity among its community members. Our values regarding equity and diversity are linked with our unwavering commitment to excellence in the pursuit of our academic mission.

Accessibility 

CQuIPS is committed to the principles of the Accessibility for Ontarians with Disabilities Act (AODA). As such, we strive to make our recruitment, assessment and selection processes as accessible as possible and provide accommodations as required for applicants with disabilities.

Land acknowledgement 

CQuIPS wishes to acknowledge this land on which the University of Toronto operates. For thousands of years, it has been the traditional land of the Huron-Wendat, the Seneca and the Mississaugas of the Credit. Today, this meeting place is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land.

Dr. Kelly Smith appointment formalizes CQuIPS and Michael Garron Hospital partnership

Dr. Kelly Smith

In the fall of 2021, Dr. Kelly Smith joined Michael Garron Hospital (MGH) as their inaugural Michael Garron Chair in Patient Oriented Research. The move was strategic for many reasons: as the hospital’s first research chair, she will pave the way for expanded research opportunities; she will support a move to spread the hospital’s quality improvement (QI) work into the community; and her arrival means the beginning of a formal relationship with the Centre for Quality Improvement and Patient Safety (CQuIPS).

“Partnering with CQuIPS was an important part of my deliberations in taking on this new role,” Dr. Smith said. “I was looking for collaborators who already spoke my language of quality and safety – people who were interested in really transforming healthcare.”

Dr. Jeff Powis, medical director, Quality, Operational Excellence, Research & Innovation at MGH, advocated for the partnership with CQuIPS.

“I have seen the benefit of working with CQuIPS for my own research journey,” he said. “I found that single-centre QI work was challenging to disseminate outside of my own organization but, working with CQuIPS, I found partners who were interested in tackling similar problems and working on issues collaboratively. This led to much higher quality QI work that had a better chance of publication. Our partnership with CQuIPS is important because we want to make sure Kelly had access to the tools and connections that allow will her research to be successful and amplified.”

A couple months into her new role, Dr. Smith is already embedded in the work of the Centre – she’s supporting work with LOFT Community Services, an organization that supports people living with mental and physical health issues, addiction and those who are experiencing homelessness.

“LOFT and Michael Garron Hospital are collaborating on a new initiative called The Path Home, which meets a big need the hospital has identified – how to improve the pathway for patients with mental health issues to get across the continuum of care,” she said. “I’m working with CQuIPS research team members to look at how we can measure the impact of this program work from the patient perspective as well as the health system perspective. We’re in the brainstorming phase but it’s exciting and I think, if it can be scaled, it could be very, very impactful.”

Dr. Smith’s work doesn’t just consider the patient perspective – she has a lot of experience in making sure patients have a valued seat at the table.

“My role is to elevate and amplify the patient voice specifically within quality improvement and patient safety activities in a way that makes sustainable change for the health system,” she said. “We need to look at pain points in the health system, where the patient voice can be leveraged to overcome some of those pain points and look at how we can co-create a future of healthcare together.”

That includes beyond the walls of the hospital. MGH is the hub for East Toronto Health Partners (ETHP), the Ontario Health Team (OHT) serving East Toronto. Smith’s work will also focus on engaging the OHT in CQuIPS-led training to build QI capacity throughout the community.

“Healthcare professionals are the most adaptive group of individuals in the world: over, under, around and through, they are figuring out how to make it work for the patient and for themselves,” Dr. Smith said. “What’s exciting about the potential of engaging our external health partners in CQuIPS training is creating a sense of community around QI and helping do more QI on scale.”

Dr. Powis agrees.

“Throughout the pandemic, we’ve been able to demonstrate the real value of partnership and integrated healthcare working with our East Toronto Health Partners,” he said. “We’ve shown that our success is based on the strength of our partnerships.  If we all have the same vision of consistently improving, if we speak the same language and we all have the same set of tools to get there, it just makes our collaborative work so much easier – it’s part of what I consider vital to be an integrated healthcare system. We’re excited to work with CQuIPS and expand QI capacity across ETHP.”

Dr. Brian Wong, CQuIPS director, said the partnership between CQuIPS and Michael Garron is an important step in the Centre’s vision to grow the QI community and focus on health system resilience.

“We consistently see that when organizations work together, the impact is far greater than each of us working alone,” he said. “Dr. Smith is already a connector herself – between Michael Garron, the East Toronto Health Partners and CQuIPS – and I have no doubt that list will continue to grow. She is a world-class researcher in this area and we are fortunate to have her here in Toronto.”

CQuIPS welcomes five new faculty members

CQuIPS is thrilled to welcome five new members to our EQUIP, Certificate Course and Co-Learning program faculty. As Canada’s leading quality improvement and patient safety training centre, CQuIPS made a commitment in our 2020-24 strategic plan to expand our faculty to include individuals from new and diverse fields of expertise. Our new faculty include three physicians, a speech-language pathologist and an occupational therapist who work in varied clinical settings spanning acute and long-term care. They bring with them years of experience leading QI and patient safety initiatives and inspiring others to think critically about how to engage meaningfully in improvement work.

“Our goal is to build QI capacity in our healthcare system and these five new faculty members are already doing that in their own organizations,” said Brian Wong, CQuIPS director. “We are excited to have them teach the next generation of learners, especially because they bring unique perspectives of how QI can be integrated into every area of healthcare from paediatrics to mental health to surgical oncology. Everyone has the power to incorporate QI into their own work and the more people who do that, the bigger the impact we will see throughout the entire system.”

A special welcome and congratulations to our new faculty members.

Certificate course faculty
Jenn Wong, professional leader for speech language pathology, Sunnybrook
Jenn Wong was introduced to QI through CQuIPS’ certificate course and that was it.

“It might sound a bit trite but it was life-changing,” she said. “It really changed the trajectory of where my professional life has gone. It opened up a lot of doors for me in terms of expanding my skillset, changing the way I think and giving more structure to some of the ideas, thoughts and goals I had.”

Now the professional leader for speech-language pathology (SLP) at Sunnybrook, Wong uses QI in everything from her work as a leader, to the fellowship she’s completing with CQuIPS, to building QI capacity in her SLP team. The next step, she says, is to pay it forward as a faculty member for the very certificate course that first got her hooked on QI.

“There’s a lot of capacity for interprofessional work in QI and we have a role to play there,” she said. “Sometimes when I talk to colleagues who are primarily clinical in background, they think they’re not smart enough or don’t have the mind to work in QI. I want to help people understand that QI is not an intelligence thing – it’s something you can develop skills for. So I see this as scaffolding for people and being able to meet them where they’re at and push them to the next level.”

Mostly, Wong said she’s looking forward to spending more time in the CQuIPS community.

“I’ve never been able to replicate the feeling that CQuIPS has – even though everyone has such a wealth of knowledge and expertise, they are continually helping build you up and motivate you. Joining the faculty is an exercise in creating joy in my work life because this program is so rewarding.”

Nicole Thomson, Senior Director of Quality, Innovation, Patient Safety and Experience, CAMH
When you think about quality improvement and patient safety, the area of mental health and additions may not immediately come to mind. Through her role as certificate course faculty member, Nicole Thomson wants to change that.

“As an academic discipline, quality and safety in healthcare are predominantly focused on physical health, and yet the principles of QIPS are equally as relevant in mental health and addictions,” the occupational therapist by background said. “For me, I also bring a rehabilitation perspective while considering quality improvement and patient safety in mental health research and practice.”

Two years ago, Thomson was instrumental in arranging a CQuIPS-led workshop at CAMH to help build QI capacity among staff. She has continued her goal to incorporate more QI in the organization through her work as senior director overseeing quality, patient safety and patient/family experience, where QI is embedded in her daily work.

Now she wants to help drive system-level improvements.

“It’s no longer appropriate for leadership teams to decide what the improvement ideas are and push those down; I think we’re at a point in time where we need grassroots improvements ideas informed by patients, families and clinicians who are empowered to lead those projects.”

She sees the CQuIPS certificate course as one method for making that change.

“The program is not just about engaging people in the quality improvement process – it’s about giving them the tools and confidence they need to support and lead QI initiatives,” she said. “If we want to see system-level improvement, we need all hands on deck.”

EQUIP faculty
Bourne Auguste, staff nephrologist, Sunnybrook
Bourne Auguste perpetually has a quote stuck in his head from IHI Senior Fellow Paul Batalden: “In healthcare everyone has two jobs: to do your work and to improve it.” This is a fundamental belief Auguste holds.

“Everyone should have some baseline experience as it relates to QI because we need to make sure our patients are receiving the most efficient, safest care – it has to address all six domains within quality,” he said. “Basic exposure and understanding of QI principles will go a long way in advancing the quality of care in our heath system.”

As a nephrologist at Sunnybrook, Auguste has been supporting the expansion of home dialysis. He said as a relatively new type of therapy, there are “tons of opportunities” for streamlining and improving the program. Auguste has specifically been focusing on bringing equity into the picture.

“COVID has highlighted a lot of disparities that exist in terms of the care offered to patients, particularly in the virtual realm setting. I’m focused on ways where we can enhance education around equity and create a more efficient system by reducing marginalization in different parts of the population,” he said. “The equity lens is one area I will lend my experience to as a member of the CQuIPS faculty.”

As a former graduate of CQuIPS’ certificate course, Auguste said he’s looking forward to joining the EQUIP team.

“I’m humbled and grateful for this opportunity,” he said. “I believe in lifelong learning and even though I’m joining on to help teach others, I know I’ll also learn a lot from more seasoned faculty so I see this as a significant symbiotic relationship.”

Genevieve Bouchard-Fortier, gynecologic oncologist, UHN and Sinai Health System
In 2016, Genevieve Bouchard-Fortier had just joined a new team. Having known about the importance of QI from her time a few years prior at the Harvard School of Public Health, she started looking for more ways to integrate it into her surgical work and realized few people on her team had experience in the area. So she signed up for CQUIPS’ certificate course.

“Having that certificate gave me the tools to be more useful to the organization and led me to get involved in the QI leadership in OB-GYN and within the surgical department,” she said. “It is extremely valuable to understand the theory behind improvement sciences and to meet mentors in QI.”

As she joins the EQUIP faculty, Bouchard-Fortier is excited to share what she’s learned with the next generation of surgical leaders. Her areas of focus are integrating QI into surgical practice and perioperative care and using data to better understand patterns of care and opportunities for change.

“This is so important because there’s no question that when you ask a patient what really matters to them, it’s having the best outcome and being safe – no matter their diagnosis,” she said. “And for healthcare providers, it’s much easier and less stressful for physicians to work in a system that has a strong QIPS platform because no one wants to make mistakes – we all want to optimize care for our patients.”

Co-learning faculty
Beth Gamulka, hospital-based paediatrician, SickKids and North York General Hospital
Twenty years ago, Beth Gamulka chaired a quality management committee – with no formal quality training.

“I was doing QI without knowing how to do it,” she said. “We had the same goal of reducing errors but we weren’t working as methodically and effectively as we would today. We were just kind of winging it.”

Almost 20 years later, Gamulka completed CQuIPS’ Co-Learning Curriculum which not only made her confident for the first time in her QI skills, it also sparked a passion for improvement. She’s since worked her way through the EQUIP program, become one of CQuIPS’ inaugural fellows, is now part of the Co-Learning faculty and is set to become an associate director for the program.

“My gateway drug was the co-learning course,” she said. “I fell in love with it – it spurred me on to do more.”

Now as faculty for the program that impacted her in such a significant way, Gamulka said she sees an opportunity to have the same type of impact throughout the healthcare system by teaching more people QI early in their careers.

“The co-learning program is the biggest bang for your buck because you get to expose a huge swath of trainees and fellows to QI work,” she said. “Right now, physicians are expected to do QI work on their own and if you don’t know the how and why, you’re never going to do it effectively – that’s why these types of programs are so important.”

Gamulka is actively trying to get new divisions into the program, incorporate more community-based organizations in QI work and help more people understand that QI is accessible to everyone.

“QI is easy to understand and can be hard to do,” she said, “but you don’t need to know anything complicated – you just need to know your patients and your problem.”

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