Ontario Health, the super-agency set up by the Ford government to oversee Ontario’s health system, has just made a decision that will hurt the quality of cancer care in this province. This decision hasn’t received wide attention, but it’s causing concern among those involved in cancer treatment.

The Quality Management Partnership (QMP) was established in 2013 after it was discovered that women had undergone unnecessary mastectomy as a result of mistaken pathology diagnosis.

An external review panel investigated this terrible mishap and advised the health ministry to establish a process to improve provincial cancer diagnosis quality.

Pathologists are the medical specialists who diagnose cancer. Poor quality pathology diagnosis can lead to tragic outcomes like unnecessary breast removal. The ministry directed Cancer Care Ontario (CCO) and the College of Physicians and Surgeons of Ontario (CPSO) to respond to the panel’s recommendations to improve pathology quality, and the collaboration of these two groups resulted in the QMP.

Improving pathology diagnostics requires a focus on laboratory processes as well as the professional skills that pathologists rely on. The collaboration of CCO (responsible for improving processes in cancer care) and the CPSO (responsible for ensuring high professional skills in Ontario doctors) was ideal for improving diagnosis through the Quality Management Partnership.

Over the past four years, quality standards in cancer diagnosis have been developed, and today Ontarians are starting to benefit from improvement in cancer diagnosis through the work of the QMP. But now, although it is far from completing its task, QMP has been terminated by the Ontario Health board in a budget-cutting exercise.

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This would never have been acceptable when CCO was governed by its own independent board, rather than the super-agency Ontario Health board.

CCO’s board (prior to being fired by the government) would not have allowed management to respond to government’s impossible choice of terminating quality services or cutting clinical services to achieve budget targets.

The chair of the CCO board would have been in the minister’s office and the premier’s office, protesting that the minor savings associated with terminating quality were not worth the risk of another unnecessary mastectomy. However, the chair of Ontario Health, possibly unaware of the crucial importance of cancer diagnosis quality, apparently accepted the budget cut imposed by the government without protest.

The decision by the Ontario Health board to terminate funding for a quality initiative reminds us of the risks resulting from the February 2019 announcement of the super agency. Simultaneous with that announcement, the boards of 20 health agencies were fired. Since then, all meetings of the OH board have been held in camera with no public notice of agendas, minutes or locations of meetings. The decision to terminate the QMP is one of the first public decisions made by the board.

Terminating an important cancer quality program begs the question of whether the OH board understands that it is responsible for the governance of quality of care across the Ontario health system. It has taken on responsibility for the board quality committees of multiple provincial health agencies including CCO, Trillium Gift of Life organ transplantation and the 14 regional Local Health Integration Networks (LHIN). The LHIN board quality committees were also terminated with the formation of Ontario Health.

These now-terminated quality committees reviewed health system outcomes with their management teams on a regular basis. What I hear now from these agencies is that they are not being asked to report to the OH board on quality.

Is there risk to patients from abolishing a board focus on quality? Management teams responsible for specialties like cancer care, organ transplant and kidney care, as well as the regional health system, must be held accountable for the quality of care they are providing.

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This can only happen through the establishment of a quality culture that begins at the board governance level. Since 2010, Ontario has been recognized internationally for the emphasis on board governance of quality initiated by the Excellent Care for All Act. This leadership is rapidly disappearing.

The termination of the Quality Management Partnership to solve a minor budget challenge suggests that the Ontario Health board may not entirely understand its responsibility for ensuring Ontarians have a safe and effective health system. This is a concern for anyone who relies on Ontario health care.