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Open Access Research article

Ontario primary care reform and quality improvement activities: an environmental scan

Shannon L Sibbald12, Charmaine McPherson3 and Anita Kothari1*

Author affiliations

1 School of Health Studies, Western University, Labatt Health Sciences Building, Room 222, London, ON N6A 5B9, Canada

2 Faculty of Information and Media Studies, Western University, London, Canada

3 School of Nursing, St. Francis Xavier University, Antigonish, Box 5000, Nova Scotia B2G 2W5, Canada

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Citation and License

BMC Health Services Research 2013, 13:209  doi:10.1186/1472-6963-13-209

Published: 10 June 2013

Abstract

Background

Quality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province.

Methods

Data were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process.

Results

The environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked.

Conclusions

Within the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.

Keywords:
Quality improvement; Primary healthcare; Human resources; Environmental scan; Policy analysis