The history of the Saskatchewan Health Quality Council
Established in 2002 as the first organization of its kind in Canada, the Health Quality Council (HQC) has worked with patients and families, clinicians, administrators, researchers, students, and quality improvement specialists to accelerate improvement in the quality of health and health care in Saskatchewan.
The past few decades have been an exciting journey. While our objects outlined in the Health Quality Council Act have remained constant, the ways we support our partners have changed over the years. Explore the timeline below to read about some of the highlights.
The Health Quality Council: The beginning
Saskatchewan’s journey into healthcare improvement began in 2001 with the Saskatchewan Commission on Medicare’s release of a report called Caring for Medicare – Sustaining a Quality System, led by Kenneth J. Fyke. The report proposed a profound transformation of the health care culture of Saskatchewan. Among other recommendations, the report identified the need for a council to monitor the quality of health care in the province. As a result, Canada’s first health quality council was created in Saskatchewan in 2002.
The Health Quality Council through the years
In the early years, the Health Quality Council’s primary goal was to build a case for why Saskatchewan needed to focus on quality. With this perspective, we conducted administrative data analyses to understand how the health system was performing and produced reports to illustrate the gaps in quality the system was facing. The Health Quality Council also supported the development of infrastructure to support dedicated and ongoing improvement efforts in the former health regions and took a lead role in building capacity for staff working in these dedicated quality improvement departments. Throughout this period, we identified high-performing health care systems from around the world to learn from their approaches to delivering high-quality care with a goal of bringing those learnings and best practices back to Saskatchewan.
With a foundation for quality improvement in Saskatchewan established, the Health Quality Council progressed towards building a strong foundation in improvement science and methods across multiple levels in the health care system. This involved providing tools and training for leadership development, clinician engagement, and measurement infrastructure, all of which combined would help organizations build their own capacity for quality improvement.
Timeline of highlights
The following are some of the Health Quality Council’s milestones as we have worked to accelerate the improvement of health and health care across Saskatchewan:
2003 – HQC secures an initial Data Sharing Agreement with Saskatchewan Health
In 2003, the Health Quality Council secured an initial Data Sharing Agreement with Saskatchewan Health. This was a historic event, because access to this level and breadth of administrative data had never been provided before in the province. With this data we were able to link various data sources (e.g. drug usage, hospitalization, physician billing, health care coverage) to identify areas for improvement within the province. Access to this data was a landmark event that helped the province move closer to using real-time data to drive improvement efforts and decision-making.
2004 – HQC releases its first Quality of Care Report
In 2004, the Health Quality Council released our first Quality of Care Report – 13 more will follow over the next six years. These reports examined the quality of various aspects of care in the province. With each report, we shared our findings with stakeholders and then worked with them to identify opportunities to improve the quality of care.
2004 – HQC launches the province’s first Patient Experience Survey
In 2004, in partnership with all the former Saskatchewan health regions, we launched the province’s first Patient Experience Survey designed to give patients a voice in their care. The survey was the first instance patients across the province had been asked what they thought about their care. Starting to measure and understand the patient experience was integral to moving toward patient-centred care in Saskatchewan. This ensured the system focused improvement efforts in areas that were most important to patients.
2005-08 – HQC launches a series of Collaboratives with health system partners
Between 2005 and 2008, we applied the Institute for Healthcare Improvement’s Breakthrough Series Collaboratives with health system partners to help make “breakthrough” improvements in quality while reducing costs. One of the most significant Collaboratives the Health Quality Council led was the Chronic Disease Management Collaborative which involved approximately 15,000 people living with diabetes and coronary artery disease, 13 regional health authorities, more than 25% of all family physicians, and hundreds of other health care workers, including nurse practitioners, nurses, educators, pharmacists, dietitians, and First Nations and Métis groups. Together we focused on improving diabetes and coronary artery disease care and using clinical practice redesign to improve access to family physician visits.
A Collaborative is a learn-by-doing approach to quality improvement. It brings together practitioners from various disciplines and multiple sites to learn and share ideas on improving their practices, based on evidence-based research. Collaboratives involve a combination of theory and hands-on practice that help participants work to address challenges in their work environments while also building capacity for quality improvement methodology. Collaboratives have been used across the world to target complex, large-scale changes across a variety of organizations.
2007 – HQC signs a Master Data Sharing Agreement with the Ministry of Health
In 2007, a Master Data Sharing Agreement was signed between the Health Quality Council and the Ministry of Health. This development helped decrease lead time to access data and helped us access an increasing number of databases, variables, and years available to inform our measurement, analysis, and research.
2008-10 – HQC supports the health care system with the Quality as a Business Strategy Learning Collaborative
From 2008 to 2010, we supported the health care system through the Quality as a Business Strategy Learning Collaborative. This leadership program brought together approximately 200 senior managers and board members from 31 organizations across the health system. Here, leaders learned how to integrate management for quality into their organizations. The Collaborative also served as a forum for crucial conversations about what it meant to operate as one system and how this shift in thinking could improve patient outcomes. The outcomes of this work led to the creation of the first common Strategic Intent as a system – that is still used today – including the ambition to “think and act as one.” This ambition spurred the recognition of the need for a provincially coordinated approach to offer high-quality health care to the residents of Saskatchewan.
2009 – Saskatchewan’s journey toward creating a culture of patient-and family-centred care was initiated by a call to action from the Patient First Review
In 2009, Saskatchewan’s journey toward creating a culture of patient-and family-centred care was initiated by a call to action from the Patient First Review: “That the health system make patient- and family-centred care the foundation and principal aim of the Saskatchewan health system.” Over the next three years, HQC collaborated with our health system partners to complete education through the Institute for Patient- and Family-Centred Care, establish a provincial framework and network, and create Patient and Family Advisor (PFA) roles to actively engage patients and families in quality improvement. This work aimed to incorporate the four pillars of patient and family-centred care that is used across Saskatchewan: dignity and respect, information sharing, participation, and collaboration.
2010 – HQC brings together family practices and care providers for a second Chronic Disease Management Collaborative
In 2010, we brought together approximately 50 family practices and 170 other care providers such as nurse practitioners, specialists and office managers, in the second Chronic Disease Management Collaborative. This Collaborative was aimed at improving the quality of care for people living with Chronic Obstructive Pulmonary Disease (COPD) and depression. Using the Institute for Healthcare Improvement’s (IHI) Learning Collaborative methodology, we supported improvement work that led to more accurate diagnosis, treatment and monitoring for thousands of patients.
2012-15 – HQC supports a system-wide commitment to continuous improvement learning through the development of the Lean-Improvement Leader’s Training program
From 2012 to 2015, HQC supported a system-wide commitment to continuous improvement through the adoption of Lean methodology. This represented another step toward the health care system thinking and acting as one through the development of shared improvement methods, tools, and language. HQC contributed to the sustainability of this learning by developing the Lean Improvement Leader’s Training (LILT), a program for managers, supervisors and other improvement champions who want to develop the knowledge and skills to lead their staff in applying continuous improvement methods to their work. LILT has been offered across the province since 2014, and it is still being offered today.
2013-18 – HQC houses the Emergency Department Waits and Patient Flow Initiative in partnership with the Ministry of Health
From 2013 to 2018, in partnership with the Ministry of Health, we housed the Emergency Department Waits and Patient Flow Initiative to reduce wait times and improve patient flow. Our researchers developed computer simulation models of how patients move through their episode of hospital care to identify key pressure points where interventions, including community-based services, would have the greatest impact on reducing wait times. These models informed the decision by government and regions to invest in developing better-coordinated care in the community and hospitals. This initiative gave rise to a new health system priority for connected care for the people of Saskatchewan. Connected care aims to reduce the historical reliance on acute care by meeting people’s care needs closer to home in their community.
2016 – Saskatchewan adopts an “Open Family Presence” policy, ending traditional visiting hours
In 2016, Saskatchewan adopted an “Open Family Presence” policy, ending traditional visiting hours- a change spearheaded by the Patient- and Family-Centered Care Guiding Coalition co-led by the Health Quality Council. The Guiding Coalition included patient and family advisors, staff representatives from the 13 former health regions, the Ministry of Health and other partner agencies (3sHealth, eHealth and the Saskatchewan Cancer Agency). As a result of the policy, families are recognized as partners in the patient’s care and patients can have their loved ones with them to the degree that they wish, rather than restricted to specific visiting hours.
2017 – The Health Quality Council launches its first cohort of the Clinical Quality Improvement Program
In 2017, 16 Saskatchewan doctors were the first participants in the new Clinical Quality Improvement Program, which the Health Quality Council launched in collaboration with the Saskatchewan Medical Association (SMA) and the provincial Ministry of Health. The 11-month course is designed to build capability among physicians and other clinicians for facilitating and leading successful health care improvement work in Saskatchewan. Several alumni from the program are now in leadership positions in the health system, applying a clinical quality improvement lens to how they lead within the system.
2017 – HQC launches Choosing Wisely Saskatchewan
In 2017, HQC took on provincial coordination of the Choosing Wisely Saskatchewan campaign to build awareness and understanding about unnecessary tests, treatments, and procedures among Saskatchewan physicians, patients, and the public. HQC also collaborated with the Saskatchewan Medical Association, the University of Saskatchewan’s College of Medicine, patient and family advisors, and other health system partners to raise the profile of the campaign provincially.
2017 – Partnered with other organizations as part of the Saskatchewan Centre for Patient-Oriented Research (SCPOR)
Launched in 2017, SCPOR collaborates with research teams and trainees within Saskatchewan to build their capacity to conduct patient-oriented research (POR) in a responsive, equitable, and innovative manner. SCPOR is one of 11 POR units under the Canadian Institute for Health Research (CIHR) Strategy for Patient-Oriented Research initiative. SCPOR mentors POR researchers in the fundamental components of engaging patients as active team members, and offers program support to teams conducting strategic POR projects through the Saskatchewan Learning Health System.
2019 – Launched BestPractice Physician Panel Reports
Panel reports are standardized reports designed for family physicians. Using administrative health data, it provides physicians with select information about their patient panel (such as health service use). The reports provide actionable and timely data that can support decision-making, quality improvement, and in turn better clinical outcomes and a higher quality of care.
HQC, in partnership with the Saskatchewan Medical Association (SMA), launched the first iteration of the panel reports for Saskatchewan family doctors in 2019. Updates to the report followed in 2021 and 2022.
2020 – Supported George Gordon First Nation
Part of HQC’s 2019-24 strategic focus was on First Nations and Métis health and wellness. To that end, HQC offered in-kind data and QI support to the George Gordon First Nation as they developed a community health and wellness survey. This project allowed for complete adherence to the OCAP® principles (the First Nations principles of ownership, control, access, and possession) as all data and decisions around the data were turned over to George Gordon First Nation.
By accessing and understanding their health data, First Nations and Métis communities can make decisions to better meet their needs.
2020 – Contributed to research studying the impact of dementia in older adults during COVID-19
Funded by the Canadian Institutes of Health Research and led by researchers at McGill University, the aim of this work was to help minimize the direct and indirect consequences COVID-19 on those living with dementia and their caregivers. HQC analyzed administrative data and health care use – such as physician visits, hospitalizations and long-term care – of dementia patients before and after the COVID-19 pandemic. Other partners include the Alzheimer Society of Canada, provincial Alzheimer societies, the Public Health Agency of Canada, the Canadian Foundation for Healthcare Improvement, the College of Family Physicians of Canada, the Canadian Geriatrics Society and Dementia Advocacy Canada.
2020-21 – Supported the health system during COVID-19
At the start of the COVID-19 pandemic in early 2020, HQC staff were seconded to assist the Saskatchewan Health Authority with the health system response. They contributed approximately 3,000 hours of resourcing to support functions such as administration, project management, communications, research, evidence, facilitation, quality improvement (QI), training and information delivery.
This work continued into 2021, as vaccination clinics began to ramp up throughout the province. HQC staff contributed their energy and talents to vaccination efforts, providing valuable project management and QI input. In late 2021, as the provincial proof-of-vaccination program was launched, HQC staff continued to help by providing program assistance to eHealth Saskatchewan.
Fostering relationships with our provincial partners is vital to maintaining a strong, capable health system and ensuring the future of quality health care in Saskatchewan.
2021 – HQC launches Community QI Collective
The Community QI Collective is an online, applied program aimed at community-based organizations working to improve child and youth mental health and well-being. Teams are introduced to QI using a mix of theory and application of concepts. By the end of the six-month program, participants will have built a QI toolbox of techniques, tools and knowledge to apply to future work—all while building a community of improvers.
2021-22 – Partnered with Saskatchewan Alliance for Youth and Community Well-being (SAYCW)
In October of 2021, HQC took over as lead sponsor of SAYCW, a health-education-community partnership dedicated to improving the health and well-being of the Saskatchewan population. The following April, SAYCW released its Mental health action report, using data collected from its 2019 Thriving Youth, Thriving Communities survey. Within the report is insight from the province’s young people on topics ranging from mental health and substance abuse to school engagement and traumatic experiences.
2021-22 – Partnered with the Federation of Sovereign Indigenous Nations (FSIN) to analyze First Nations self-harm and suicide data
In this important partnership, HQC conducted research on the quality of care received by First Nations people in Saskatchewan related to suicide and self-harm. We analyzed 20 years’ worth of administrative health data on people admitted to hospital for intentional self-harm, as well as mortality data on suicides from the Saskatchewan Coroners Service. The final report, Self-harm and suicide in First Nations communities in Saskatchewan, was released in October 2022. The report shines a spotlight on the grim reality: There is an alarmingly wide and growing gap between the rates at which First Nations people are attempting and completing suicide, and rates in the rest of the Saskatchewan population.
2022 – Established the Youth Mental Health Sharing and Learning Community
The Youth Mental Health Sharing and Learning Community was created to serve as an interactive virtual space that brings people together in Saskatchewan around the topic of youth mental health. Individuals and organizations can build relationships with others working in this space, share ideas, share the progress of current work, and engage in a process of collective learning. By creating a space to share and learn from others, the Youth Mental Health Sharing and Learning Community is an opportunity to build relationships, explore what is working, and examine future collaboration opportunities to improve youth mental health.
The Health Quality Council: Looking ahead
Over the next number of years, the Health Quality Council will expand our role by collaborating with new partners who are already working to explore some of the root causes of health and wellness to improve the health and quality of life of Saskatchewan citizens. We will engage First Nations and Métis partners in hopes to contribute to their work towards improving health and wellness in First Nations and Métis communities. We will also work with human services and community-based organizations to address the social determinants of health to optimize programs and services that support the mental health and wellbeing of children, youth, and their families.