Health Quality 5.0: The Global Health Workforce Crisis - First Things First.

The future of quality is personal. Health Quality 5.0 moves people-centred, integrated health and social care systems to the forefront of our post-COVID-19 agenda - and that cannot happen without addressing our global workforce crisis. Building back a stronger, healthier workforce is the first of the five big challenges we address in our special series. Starting with the global health workforce crisis is fitting, given it is the most fundamental and formidable barrier to health and quality today. As we put the pieces of the Health Quality 5.0 puzzle together, a picture of a more resilient health system will emerge and a new leadership agenda to get there will take shape.

It Is Time for Health Quality 5.0: Are You Ready?

The work of health leaders is broadening in scope, scale and urgency to respond to massive global changes and challenges - including risks to safe, accessible and high-quality healthcare, threats to planetary health, crises in workforce resiliency and erosion of public trust and confidence. To address these issues and deliver on other imperatives around equity and inclusive service co-production, health leaders must again fashion a new quality improvement (QI) agenda fit for the times and the future, aligned with the move from digitization to personalization. The new era, Health Quality 5.0, must enable and be embedded in an integrated, coordinated and people-centred health system, supported by a learning health system and new QI approaches.

Is Your Organization "Accreditation Ready" Every Day?

External, third-party evaluations are undertaken across every industry, including healthcare, to assess performance against an established set of standards. The formality, rigour, timing and outcomes associated with these evaluations vary, and models throughout the world are evolving to meet changing needs. This is aligned with the historic shift from periodic pre-determined accreditations to healthcare organizations being "accreditation ready" every day. Accreditation Canada's continuous quality improvement model empowers and enables organizations to foster a culture and practice of continuous quality improvement.

People Powered Health™:: Taking Front-Line Ownership to the Next Level.

Collaboration is a powerful force of social change. History has shown us time and time again that when people come together with a shared passion for making things better, high impact change can happen. Minds are opened. Voices are heard. Lives are saved. Our experience at Health Standards Organization (HSO) and Accreditation Canada shows that when people feel involved, empowered and engaged in a meaningful way to bring about improvement, then the chances that it will be sustained over time increase as well. This paper builds on the principles of front-line ownership (FLO) initiatives offered by Gardam et al., addresses the tensions between standards and innovation and reminds us that collaboration is all about people, and people power is what converts theory and ideas into reality - especially in healthcare environments.

Contract management of Ontario's cancer surgery wait times strategy.

The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.

Harnessing collaborative technology to accelerate achievement of chronic disease management objectives for Canada.

Morgan and colleagues put forth a call to action for the transformation of the Canadian healthcare system through the adoption of a national chronic disease prevention and management (CDPM) strategy. They offer examples of best practices and national solutions including investment in clinical information technologies to help support improved care and outcomes. Although we acknowledge that the authors propose CDPM solutions that are headed in the right direction, more rapid deployment of solutions that harness the potential of advanced collaborative technologies is required. We provide examples of how technologies that exist today can help to accelerate the achievement of some key CDPM objectives.

Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

PURPOSE: A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. DESIGN/METHODOLOGY/APPROACH: The paper provides an outline of the CCO performance management system. FINDINGS: These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. PRACTICAL IMPLICATIONS: The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. ORIGINALITY/VALUE: The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.

Integration of cancer services in Ontario: the story of getting it done.

Leaders in healthcare have known for years that integrating service delivery makes sense, yet paradoxically across Canada, despite major system restructuring, cancer care has remained the exception. In Ontario it was recognized that this was an area both ripe for and in need of change. The economic impact associated with the growing burden of cancer in Ontario has been well documented. Also well documented are the potential solutions for how cancer services could be better integrated and organized to improve efficiency and quality of care. Until recently, however, little action was taken. Traditional biases, turf protection, political minefields and perhaps even restructuring fatigue have been excuses to stand still.