Over the past 20 years, Ontarians have enjoyed definite improvements in health care quality. Premature death from all causes in the province has been reduced, wait times for surgery are better, and hospital mortality, infection rates and efficiency are all better.

In the community sector, more Ontarians are attached to primary care providers and more than 90 per cent of clients rate home care as good to excellent

Cancer survival is as good or better in Ontario than anywhere else in the world, international best practices in cardiac and stroke care are developed in this province and North America’s premier transplant hospital is in Toronto.

This improvement in quality has been accelerated by The Excellent Care for All Act, proclaimed in 2010. This legislation introduced the independent body Health Quality Ontario to report objectively on quality across the health system and introduced new standards of quality management to hospitals, provincial agencies and community organizations, including Local Health Integration Networks (LHINs).

One of the most important initiatives introduced by this quality legislation was to mandate the importance of volunteer governance boards in achieving a quality strategy for these health provider organizations. The act required the boards to establish quality committees. The provider organizations were required to develop quality improvement plans that needed board review and approval. Importantly, under this legislation, boards needed to change senior management compensation to ensure that variable pay would be related to quality performance

This importance of board engagement in health quality improvement has also been emphasized by international organizations like the U.S. Institute for Healthcare Improvement, NHS Improvement in Britain and the Canadian Patient Safety Institute. These associations have described the importance of promoting a “quality culture” within health organizations that needs to be driven from the top by the board.

With the collapse of 20 health agencies under the Ontario Health board under the new Peoples Health Act, it is likely that the momentum of quality improvement will slow down in Ontario. The 15 members of the Ontario Health board now responsible for all these agencies cannot possibly put the same focus on quality that was evident with 16 specialized cancer, transplant and LHIN board quality committees.

And with the Ontario Health board terminating 170 Cancer Care Ontario jobs — many responsible for quality — cancer leaders are worried the board is sending the wrong message from the top of the organization to cancer providers.

The board of Ontario Health seems to think that only front-line workers are needed to provide health care and the back-office staff responsible for measuring and comparing quality as well as holding clinical programs accountable for high quality results can be disposed of. It is naïve to think that busy clinicians can both provide care and do the data collection and analysis that quality improvement requires without back office support.

With respect to quality improvement in regional community programs, the LHIN boards and their quality committees are finished. These quality committees were particularly valuable in bringing a local context and emphasis to quality improvement. Different challenges exist in different parts of the province and having 14 LHIN board quality committees assessing services and outcomes across the province provided an essential regional perspective to quality improvement.

Ontario Health Teams seem to be regarded as the successor organizations for the LHINs under the Peoples Health Act. However, in the foundational information provided to organizations applying to be Heath Teams, there is no plan suggested for how they will report on quality and no information about how their quality will be reviewed at the Ontario Health board. And, it will likely take many years before all Ontarians have access to an Ontario Health Team.

Health Quality Ontario (HQO) will presumably continue in its role responsible for reporting on quality across the health system. However, its staff now report to the Ontario Health board rather than being independent. Health Quality Ontario reporting on health system performance while reporting to the board responsible for the health system is an egregious conflict of interest.

Ontarians have benefitted from health boards that have relentlessly focused on health care quality improvement. It is likely this continuous quality improvement is going to slow to a halt while the Peoples Health Act is implemented.

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Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and Deputy Minister of Health. Follow him on Twitter: @drbobbell

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