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Building organizational QI capacity at St. Mary’s General Hospital

System-level change starts by building quality improvement capacity at organizations – the more the culture reflects one of continuous improvement, the better chance for initiative success.

CQuIPS is excited to announce a new three-year partnership with St. Mary’s General Hospital to support this work. The partnership will see CQuIPS deliver multiple QI workshops to staff from across the hospital including information technology, lab and pharmacy, housekeeping and the emergency department. CQuIPS will also provide focused consultation on two key initiatives for St. Mary’s: patient ID band scan rate and time to inpatient bed.

Additionally, several St. Mary’s team members will participate in the CQuIPS’ certificate course and EQUIP program, developing advanced experts within the organization who can lead and support future QI initiatives.

“The idea behind our organizational QI capacity building is to support the hospital to lead in QI,” said Brian Wong, CQuIPS director. “We’re giving them all the tools they need to be successful in running change programs with one-on-one support from our team. We hope through this organizational capacity building work that we can contribute to building a more resilient healthcare system.”

Julie Nicholls, manager of quality and patient experience at St. Mary’s, said this partnership ties in perfectly to the hospital’s goals.

“Investing in education for staff is another way that St. Mary’s demonstrates our commitment to quality,” she said. “We are thrilled by the opportunity to provide such expertise in QI training for our staff. Our hope is that this will empower our team to build upon the excellent quality care they already provide by enhancing our collective QI capabilities with new ideas, tools and collaboration methods.”

Mercedes Magaz joins CQuIPS as QI specialist

It wasn’t until Mercedes Magaz began a quality improvement (QI) course that she realized she’d been doing QI her whole career. Though QI wasn’t the focus of her role as an internal medicine physician, she had always sought out opportunities to improve system-level issues.

“I realized in my role as a physician that my one-to-one interaction with patients was small compared to their whole journey across the healthcare system that’s often full of obstacles and barriers,” she said. “I started thinking I needed to use my clinical expertise to help the system improve.”

As CQuIPS’ new QI specialist, Magaz will have the opportunity to do exactly that.

Magaz is bringing with her more than a decade of experience including running the emergency department in one of Argentina’s best hospitals and supporting Sunnybrook’s infection prevention and control team’s QI efforts during the COVID-19 pandemic.

With CQuIPS, she will play a major role in supporting its organizational QI capacity building program, a service CQuIPS provides to train and coach teams within healthcare organizations to lead and contribute to successful QI initiatives.

“Mercedes has such a rich background to draw on for QI,” said Leahora Rotteau, CQuIPS program manager. “Her clinical knowledge and expertise are a huge asset because she understands some of the challenges healthcare organizations are facing in implementing QI work. We’re really lucky to have her on board.”

Magaz moved to Toronto from Argentina five years ago, and said she feels there is still more to learn about Canada’s healthcare system. She’s excited to flex the QI skills she began formally acquiring during her time in the Master of Health Science in Health Administration program at the University of Toronto.

“CQuIPS is the group you want to be in if you want to do quality improvement in Toronto so I am really happy and excited to be here,” she said. “I’m looking forward to diving into QI and putting QI into practice to play a part in helping people live better through these inconvenient times.”

Introducing Tara Burra, CQuIPS’ new education lead

CQuIPS is often referred to as a connector – bringing people, ideas and projects together. So it’s no surprise that Tara Burra, the Centre’s new education lead, wants to use her platform to build a better connection between quality improvement (QI) and mental health.

Burra is a psychiatrist at Mount Sinai Hospital, the first QI lead in her department and one of the creators of a new quality improvement, innovation and patient safety academic hub in the University of Toronto’s Department of Psychiatry. In addition to her clinical and QI background, she has experience revamping QI curriculum to be more effective and meaningful so clinicians have those skills embedded when they graduate.

“As trainees, we kind of get acculturated to the notion that there is a particular way of delivering care,” she said. “One of the really important parts of quality improvement and patient safety to is to question that – there could perhaps be alternative or better ways to accomplish the same end through an improvement that at the same time enhances patient experience and reduced costs. It’s also increasingly clear that it’s important we diligently address health equity through QI.”

As CQuIPS’ education lead, Burra will support the development, organization and scholarship of the Centre’s education programs with a specific focus on integrating health equity – one of CQuIPS’ two key themes – into all program aspects from the faculty, coaches and guest speakers to the content being delivered. Burra shared this is important to her as a mother of a child with a physical disability and as a woman of mixed race.

“One of the driving forces behind my interest in quality improvement and patient safety is having the direct experience of many healthcare journeys with my child,” she said. “We all contribute to ongoing improvement.”

Brian Wong, CQuIPS director, said Burra’s background makes her perfect for this position.

“As education lead, Tara will play a critical role in shaping how healthcare providers think about and approach QI,” he said. “We’re really excited to have her on board because she brings a unique perspective that complements the rest of our leadership team.”

Burra said she hopes the connections she helps form between CQuIPS and the mental health field will hopefully encourage more mental health practitioners to get involved in QI.

“One of the main reasons I was interested in this role is that the community for QI in mental health is thus far relatively small,” Burra said. “Mental health is a source of health inequity and I think it’s really important we have mental health leaders as part of the larger QI community and to elevate QIPS competency within my specialty.”

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.”

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