Write it out to save a life!

Mollie Cole is Director of Health System Improvement at the Health Quality Council of Alberta, and a registered nurse of many years.

Healthcare provider in front of white board with medical abbreviations and symbols crossed out. Text: Write it out to save a life!

As a registered nurse, I have encountered my fair share of abbreviations, symbols, and dose designations over the years. I’ve seen these used in treatment orders, prescriptions, medication administration records, care plans, clinical notes, and instructions to patients. I’m sure I was responsible for a few of these too. After all, some habits are hard to break without an occasional reminder.

That’s why, on behalf of the Health Quality Council of Alberta, I am pleased to share with you a few helpful tips and important reminders about the hazards of abbreviations, symbols, and dose designations in medical communications – and why it’s best to avoid them.

While it’s difficult to estimate the impact of this problem across Alberta, it’s not hard to find alarming studies that point to the danger of abbreviations, symbols, and dose designations in healthcare settings across the world.

One U.S. study of 30,000 medication errors, some fatal, showed five per cent were linked to abbreviations in notes.1

As many of you in the healthcare sector already know communication shorthand commonly cause medication errors and adverse events. They can lead to the misinterpretation of instructions, especially if the language has multiple meanings or is not understood by all members of a healthcare team. And while the advent of electronic medical records and order sets have likely helped to mitigate abbreviation, symbols. and dose designations use in recent years, we know from audits that abbreviations in SMS texting are increasingly being found.

The Health Quality Council of Alberta has a mandate to promote and improve patient safety, person-centred care, and health service quality, and we’ve taken a keen interest in medication safety issues over the years such as the appropriate use of abbreviations, symbols, and dose designations.

This month, we launched a new page on our website, The Hazards of Abbreviations, Symbols, and Dose Designations, that highlights efforts healthcare providers and organizations can take to reduce the temptation to use shorthand in medical communications. This page replaces our abbreviations.hqca.ca site with a concise, updated look at this important topic.

One of the valuable resources you’ll find on our new webpage is a link to the Institute for Safe Medication Practices Canada (ISMP Canada) Do Not Use List – which is a regularly updated list of abbreviations and symbols that frequently create problems in medical communication and should never be used.

“The list is based on reports of medication errors to ISMP Canada,” said Carolyn Hoffman, CEO, ISMP Canada. “Through practitioner and consumer-lived experiences, we learn and share so that all of us can act to reduce the risk of this type of preventable harm.”

To learn more about this important topic, check out the new Hazards of Abbreviations, Symbols, and Dose Designations page.

HQCA Matters is published intermittently and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

1 BBC NEWS | Health | Medical abbreviations ‘pose risk’

The advancement of patient safety relies on a just culture

In 2017, a patient died after a medication error at Vanderbilt University Medical Center in the United States. We extend our sympathies to the family who suffered this tragic loss. Many healthcare professionals watched the case carefully, as the nurse who administered the wrong medication was criminally charged.

Our view

Criminalization of a medical error diverts attention from important aspects of patient safety that support our health systems to learn and improve.

No one is more equipped to make improvements to patient safety than healthcare workers, and the patients and families they serve. Healthcare workers are at the frontline delivering and witnessing care. As a result, they are in a unique position to identify potential and actual errors. They rely on safe venues to discuss unsafe situations, and require a healthcare system that is committed to acting on their findings. When we focus on individual blame and punishment, this can create a culture of fear that shuts down transparency and fosters an environment where healthcare workers no longer feel safe to voluntarily report potential and actual errors. This ultimately makes our health systems less safe.

A just culture

Organizations with a just culture see errors as opportunities to learn and to improve the healthcare system. Healthcare workers in a just culture trust their organization and feel that staff are treated fairly when they are involved in a patient safety event, including when they make an error. Reports of errors and patient safety hazards are important sources of information about weaknesses in the system, and are used to improve patient safety.

It is vital to promoting and improving patient safety that, as healthcare leaders, we ensure our organizations have a consistent, systematic and fair approach for gathering, organizing, and interpreting information about patient safety incidents and the actions taken by those involved. This begins with a thorough assessment of an incident using a systems-based approach that supports looking beyond the contribution of the individuals involved, and considers how complex interacting elements can influence care.

Tools such as the Just Individual Assessment (JIA) support a just culture and can be used to assess individual accountability within the context of the situation, including understanding contributing system factors.

The Health Quality Council of Alberta has created recommendations on what patients and families, healthcare workers, and organizations can do to foster a just culture. Now, more than ever, we need to commit to a just culture and we invite you to join us. Please check out our just culture website and the many resources available on this important topic.

Charlene McBrien-Morrison
Charlene McBrien-Morrison, Chief Executive Officer

HQCA Matters is published intermittently and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Our deep dives into designated supportive living

Charlene McBrien-Morrison is the Acting Chief Executive Officer of the HQCA

More than 10,000 Albertans live in designated supportive living sites across the province. These sites provide accommodation, healthcare, and personal services to help residents remain as independent as possible and live their best lives.

Is that aim being met? What’s going well? And, how can the designated supportive living experience be improved?

In 2020 and 2021, the Health Quality Council of Alberta (HQCA) took a closer look at these questions in two separate deep dives:

Two common themes stood out for us.

A home-like environment
Interview after interview with residents, operators, and staff revealed the most positive experiences occur when residents feel seen and heard. Their experiences are honoured and understood. They have personal relationships with staff. And their new home, in designated supportive living, feels like their home.

Easy, right? Not at all.

We learned the transition into their new home in designated supportive living can be difficult, even at the best of times, as this move is often a sudden and major life event. It requires a period of adjustment for both residents and families.

During this transition, staff who are welcoming to the resident and their family can help. And personal relationships with staff matter. Residents appreciate friendly, patient, and cheerful staff who socialize, listen, and respect their choices and interests. For example, when staff at one site put a bird feeder on the window-sill of a bird-loving resident, her smiles spoke volumes. That was enough to feel like home for this long-time birdwatcher.

Similar stories bubbled to the surface frequently during our interviews as we set out to understand what drives a positive experience at these designated supportive living sites.

We also heard that listening is essential. Residents want input on decisions that affect them – from choosing their mattress to selecting meaningful social and recreational activities, and weighing in on the daily food menus. Importantly, it is not enough to just collect feedback. The real value is when designated supportive living sites act on feedback in conversation with residents and families.

Check out our work
To learn more about our findings in designated supportive living, I encourage you to review our work in this important area. As you’ll see, there is growing evidence of what constitutes the path to improved experiences for residents and families in designated supportive living.

Finally, we’d like to thank all of those who shared their experiences and thoughts with us. Your voices provided invaluable insights about how to keep improving designated supportive living across Alberta.

HQCA Matters is published intermittently and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Can you really improve quality and reduce cost?

Ben Higgins, Lead, Health System Analytics

From my place in the world, it seems that any change to improve the quality of healthcare is going to increase cost. Can you help me understand how improvements can maintain, or better yet, lower the cost of healthcare delivery?

Geralyn, HQCA Patient and Family Advisory Committee Member

Hi Geralyn,

What a great question, and one with an answer I am very passionate about.

In order to answer this for you, it is important to understand variation, since reducing variation is one way to improve quality and lower cost.

What is variation? Put simply, it can be a different form or version of something. Or, it could be a change or slight difference we can observe or measure. For this conversation, we are going to talk about variation we can observe or measure. Everything around us that we observe or measure, varies. Variation is expected and some variation in healthcare is desirable, even essential, since each patient is different and should be cared for uniquely.

When healthcare decision-makers are trying to decide what to focus their attention and effort on, how do they know what variation is worth investigating?

To do this effectively, they need to understand the difference between common and special causes of variation.

Before we get into some healthcare examples, let me offer an analogy to help understand these ideas. Let’s think about variation and your commute to work.

You know about how long it takes for you to get to work each day. Let’s say it’s usually between 30-35 minutes to get from home to your work site. There is no way you can pinpoint the exact amount of time it will take because of common causes of variation (public transit arrival time, traffic light timing, a short distraction with your child while getting ready, etc.). You just expect that you will arrive sometime in that 30-35 minute range and accept that variation.

But then, one day, it takes 55 minutes to get to work. There was a lot more traffic on the roads and it turns out there was a broken traffic light at a huge intersection that caused a major back-up. This longer commute is well outside of that “typical” range and the traffic light problem is an example of what we would call a special cause of variation.

It is SPECIAL CAUSES of variation that healthcare decision-makers should be investigating.

Let’s look at an example from here in Alberta’s hospitals, from the HQCA’s FOCUS website. Below is a graph showing the length of patient hospital stay compared to the Canadian average for the Queen Elizabeth II Hospital in Grande Prairie. When you take a quick glance at this graph, does anything stand out as “unusual”?

Did you say the data points from October 2016 and January 2017? These look like really sharp spikes, right?

However, guess what? The lines for the upper and lower control limits actually show us the range for normal, common cause variation. Control limits are a statistical calculation that tells us what the boundaries are for when variation is in control (inside the limits) or out of control (outside the limits).

As we can see here, while those two spikes (October 2016 and January 2017) appear unusual, they are still inside the limits and would be actually considered a normal and expected amount of variation. So, while it might be tempting to make changes to processes after observing these spikes, we would not recommend investigating this variation further. Doing so would not likely improve the length of hospital stay (because the variation observed is within the expected limits for this system) and would lead the team in an unhelpful direction, wasting time, money, and other resources (e.g. people, supplies, equipment, etc.).

Special cause variation is where we recommend decision-makers focus their efforts on improving quality to make the most positive impact. Here are three of the most useful things we look for in the data before investigating special cause:

1. A single point outside of the control limits

2. Eight consecutive points above or below the mean line

3. Six consecutive points increasing or decreasing

When you see any of these three things happen with data, it’s worth looking into further.

To come back to your question, this example of the length of stay in the hospital is also a great one to talk about the relationship between quality and cost. When these hospitals see special cause variation for the better (what we see in both the examples for the Peter Lougheed Centre and the Grey Nuns Community Hospital above), they have an opportunity to investigate further, hopefully find out why there was an improvement, and then take steps to keep achieving the positive results (by sustaining, replicating, or scaling what caused the change). In this example, if these hospitals decrease their hospital occupancy rate (how many beds are in use) by shortening the length of stay, this could reduce the overall cost to the hospital and, ultimately, the system.

On the flip side of that coin, like in the early part of the Rockyview General Hospital example, when there is a special cause in the undesirable direction, they have an opportunity to investigate and correct the situation (by stopping or avoiding what happened). As you can see from their data, either improvements were made or circumstances shifted to where they have a second string of at least eight consecutive points below the mean. This sustained improvement offers another opportunity for investigation to learn from this and try to ensure the positive trend continues.

In fact, the Rockyview General Hospital data shows that this improvement was sustained for long enough that we could actually consider this to be a new normal for operations at this hospital. Considering this is the new normal, we recalculate the control limits to reflect this:

So, what does this mean? Well, let’s break it down in a way similar to how a quality improvement team at the hospital might look at this. The measure for “length of patient hospital stay compared to the Canadian average” is made up of two pieces:

  1. The length of hospital stay for patients at Rockyview General Hospital and
  2. The expected (average) length of hospital stay for similar patients in Canada.

When the measure is broken down into these pieces, we discover that the length of hospital stay for patients at Rockyview General Hospital has decreased slightly. Over this same period of time, the average for similar patients in Canada has increased slightly. Together, these changes lead to the shift you see at the Rockyview General Hospital.

From a cost perspective, it is likely that the slight decrease in length of hospital stay for patients at Rockyview General Hospital resulted in a lower average cost per patient (because they would have spent less time in the hospital) during the period of time from March 2017 to March 2018. And, if the hospital also saw a reduced occupancy rate during that same period, the overall cost to the hospital may have gone down as well.

So, as I mentioned before, it is very easy to get caught up in the “hot” issue of the day and start trying to fix or change something that was unusual and seemed like a big deal. This is why looking more closely at variation over time with these simple rules of thumb can lead to more meaningful quality improvement and uncover potential cost savings for Alberta’s health system. Those cost savings can be realized by focusing staff on chasing more variation where there is a real opportunity for improvement, not just where we have a “hunch” change is needed.

Hopefully this answered your question and helps you see why we find data so interesting here at the HQCA. If you have any other questions for us, please just let us know. Also, if you would like to read more about variation and get a bit more technical, I recommend checking out these great resources from the National Health Service (NHS) in England: here and here.

All data presented here is available on the HQCA’s FOCUS on Emergency Departments website, which is updated quarterly. If you would like to sign-up to receive notifications when new data is available, please click here.

For HQCA Matters updates, follow @HQCA on Twitter.

HQCA Matters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.

Fox Creek Healthcare Centre uses human factors to enhance efficiency and safety

Last year, the Fox Creek Healthcare Centre planned to design a COVID-19 resuscitation room in response to the pandemic.

Shelley O’Neill, External Nurse Investigator, saw this as an opportunity to apply her learnings from the Human Factors in Healthcare course offered by the HQCA and W21C.

“I used the skills and knowledge I gained during the Human Factors in Healthcare course to enhance efficiency and safety when resuscitating patients,” says Shelley.

Human factors is a scientific discipline that evaluates and understands human interactions in relation to other elements of a system. It’s a profession that applies theory, principles, data, and methods of design in order to reduce human error, increase productivity, and enhance safety and comfort.

The resuscitation room was designed and put to the test with several clinical simulations involving more than 15 staff members. This occurred in partnership with simulation consultants (Monika Johnson and Kristin Simard) from the Alberta Health Services North Zone eSim team. Movement patterns of individuals enacting the simulation scenarios were mapped out using a Link Analysis, a human factors method.

“Thanks to the Link Analysis we were able to identify potential issues and fine tune the design of the resuscitation room to minimize cross contamination so that patients and staff can remain safe,” said Shelley.

The team identified that the initial design required clinicians to move and cross paths frequently within the room to gather needed supplies. Modifying where supplies were stored, and defining the roles of the individuals involved in a resuscitation, helped create role specific zones within the room to minimize movement and potential cross contamination.

“Enacting the resuscitation scenarios also provided opportunities to practice and helped staff feel prepared and confident in their abilities,” added Shelley.

If you would like to be informed of the next Human Factors in Healthcare course offered by the HQCA and W21C please email Jonas.Shultz@hqca.ca.

The HQCA’s resources on human factors can be found here.

Quality improvement: Where treasure hides in plain sight

Andrew Neuner, Chief Executive Officer (CEO), HQCA
Andrew has served at the HQCA as CEO since 2014 and as he departs from the HQCA, has offered some parting thoughts and reflections.

I was approached back in 2014 about the CEO position at the HQCA. At the time, I was an executive at Interior Health in British Columbia. I didn’t see how I could possibly fit in. I’m an operations guy. To be perfectly honest, I didn’t think it was something that would be a good fit for me. I didn’t appreciate the place the HQCA held in the system.

I was intrigued, though, and took the leap. The HQCA’s culture of collaboration and legislated mandate to improve healthcare with and on behalf of Albertans resonated with my core values and professional interests.

Then, once I steeped myself in the work, it didn’t take me long to “get it.” The team at the HQCA quickly showed me the power of information, how to maximize its benefits, and how this work is profoundly relevant. I have especially appreciated how the HQCA does this work and makes sense of things. The value here is immense. If Alberta’s healthcare system acted more consistently on the HQCA’s objective, evidence-, and experience-based information when pursuing quality improvement work, I believe that front line workers, patients, and their loved ones would not need to demonstrate such herculean levels of resilience.

From my experience, this is a common admission from leaders in healthcare. Healthcare quality and safety improvement can, at surface glance, seem burdensome. Costly. Overly meticulous and methodical. Work that can and often does fall low on the list of priorities.

However, when you:

  • really stop and immerse yourself in the science of improvement,
  • see an initiative through an improvement cycle (or two….or three),
  • conduct a robust evaluation to really capture the return on investment, and
  • develop a strategy to spread the improvement throughout the entire system,

the value of devoting the time and resources required to do this kind of work right becomes crystal clear.

Because there is gold to be found here, both literally and figuratively. A relentless focus on quality improves lives and reduces cost. Period.

Under the current circumstances and pressures of the pandemic response, our time and resources are increasingly precious commodities. Keeping healthcare quality top of mind in all decisions and improvement efforts is more important than ever. As I said before, the Alberta Quality Matrix for Health dimensions of quality: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety should always be our compass or ‘North Star.’

We need to make common sense, common practice.

More than ever, we must identify, understand, and act on the opportunities raised or supported by Alberta’s bright minds. I believe the capable minds and those with lived experience here in Alberta, including patients and frontline workers, are our most underused resource. Yes, meaningful engagement takes time, however working inclusively and bringing these voices together into the same space—often virtually right now, of course—to come up with creative solutions to very real problems is the key.

There are days when things in the health system can be really complicated. But for the most part, it’s not as complicated as we make it. Sometimes, we seem to go out of our way to make it more complicated through a series of endless meetings and processes that delay making good, timely decisions.

When we get into those academic, technical, or logistical weeds, or get completely side-swiped by something unexpected (e.g., COVID-19), stop ask yourself and those at your decision-making table, these questions:

  • Where is there someone with a health need?
  • Where is there someone who can help?
  • How do you bring those two things together?

And, to the decision makers and those who are responsible for the direction and performance of the whole system, you must make a reliable map for those at your decision-making table. Make sure there is a clear vision of what needs to be achieved. Help identify and communicate the priorities and strategy so that leaders are asking and answering these questions about the most critical areas to improve. Then, let the evidence guide you as you consider solutions to address the questions above.

It has been a pleasure serving Albertans for the past six years and I know the HQCA will continue to find buried treasure in search of quality healthcare for all. I remain hopeful that, when the HQCA reveals these treasures, the system will be open and willing to act appropriately on the spoils so everyone can benefit.

HQCAMatters presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.

Panel Reports – why now?

Andrew Neuner, Chief Executive Officer, HQCA 

There’s no shortage of things to think about these days if you are a family physician in Alberta.

Your practice is busy. The COVID-19 pandemic has added serious new patient questions. And in the background, we know the ongoing discussions with the Alberta government about the physician funding framework are likely on your mind.

Some of you may wonder why the HQCA chose now to release the 2020 Primary Healthcare Panel Reports.

The answer is we wanted to get this information – the most current and comprehensive data about patient panels – in your hands as soon as possible. And, frankly, some of you have been asking for it. Delaying the release runs the risk of making data less relevant.

I know all of you won’t have capacity to reflect on your panel data at this time. And that’s ok. It’s available for you to review whenever you’re ready.

With everyone focused on the COVID-19 response, the HQCA has put on hold – until further notice – our planned activities to promote these reports with physician and other healthcare audiences. That means we won’t offer webinars or pro-actively communicate about the reports in the near-term. There will also be delays in generating reports for new requestors.

There’s information on the HQCA website about what’s new with the 2020 data, and if you have any questions, please reach out to our team at primaryhealthcarereports@hqca.ca.

Thanks again for all you do to support patient safety and health service quality in Alberta.

The personal side of scale and spread

Andrew Neuner, Chief Executive Officer, HQCA

My parents live in Penticton, British Columbia. My mother has been facing increasingly challenging health issues in recent years. She has always managed the details for my family. Now, my father is learning to look after her. Our family provides additional supports in a variety of ways. I find it difficult to feel like I am doing enough from a province away.

I have no doubt that many of you are in similar situations, looking after loved ones and wondering if you are doing enough and doing it well. We take it one day at a time, and some are better than others.

We talk regularly and, as you can imagine, I always ask about my mom’s recent healthcare appointments. I am met with half-answers. My dad remembers some details, my mom fills in some blanks. There are still gaps. Gaps that make me worry. I know my mom’s providers are giving her sound advice and carefully considering her care, based on their discussions. However, much of the direction and recommendations shared in those increasingly critical appointments is lost after the interaction is over. Those gaps create risk that our family won’t be able to support my mom to the best of our ability.

This year, as part of our Patient Experience Awards selection process, I was particularly struck by one initiative: the My Care Conversations smartphone recording app. While this initiative was not selected, I felt a connection to this work because it immediately made me think of my parents. I know that tools like this have been used in other jurisdictions for some time, however the true value of a tool like this really resonated, given my mom’s and family’s current circumstances.

Then, the healthcare leader switch in me flipped and jumped to questions about privacy and confidentiality, specifically around consent to record a consult. In reaching out to the My Care Conversations project team to learn more, they addressed my questions about privacy and my focus moved on to scale and spread. What would it take to get more widespread acceptance and adoption of using this technology?

At this point in my thought process, doubt starts to creep in. In 2011, Dr. Ross Baker and Dr. Jean-Louis Denis released a report that concluded healthcare systems in Canada have experienced difficulties in creating and sustaining large-scale improvements; local initiatives are difficult to replicate and spread, and improvement efforts are often limited in scale.

Eight years after the release of this report, I see the pattern here in Alberta: excellent pilot or proof of concept at a local or sector-specific level that fails to gain traction elsewhere. So, how can we work together, to make sure that meaningful work like that done by the My Care Conversations team realizes its full potential? Because I feel, from personal experience and observations as a healthcare leader, this tool has applicability well beyond cancer care.

There are many great resources that offer evidence-based suggestions about how to overcome barriers to achieving scale and spread. A few that come to mind are:

If you have others that readers should be accessing, please pop over to my Twitter feed and add your suggested resources to this thread. Because patients and family members deserve to reap the benefits of these leading practices that support information continuity and overall continuity of care.

HQCAMatters is published monthly and presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.

“Paper” for the win

D’Arcy Duquette, Chair, HQCA Patient and Family Advisory Committee  

This is the third part in a series on the value of patient feedback. The first two installments can be found here and here.

HQCA Executive Director, Charlene McBrien-Morrison recently reflected on Alberta’s journey toward patient centredness and closed her piece by posing this question to the HQCA’s Patient and Family Advisory Committee (PFAC):

How can we (healthcare leaders focused on improving healthcare quality) do a better job of “walking the talk” of patient-centredness by listening to and acting on the voice of those we serve?

Part of my charm is being direct, so I will get straight to our recommendations with one request: Please make the commitment to read this response in its entirety. Stop the flurry of activity. Focus. Prepare to hear our PFAC’s thoughts and take the time to listen. If you can do this, thank you. You are already practicing part of our first recommendation.

1.) Come prepared to listen. No doubt when you decided you needed to engage patients in your work, some thinking had already been done around the task at hand. There may have even been some initial conversations about what solutions could/should look like. Please leave these thoughts at the door. Instead, bring your expertise and knowledge of the situation or desired outcome, and be prepared to provide us with enough context to provide you with valuable input.

If you needed to do some preliminary scoping before engaging us, be willing to revise, or even start from scratch, once you hear our perspective. We like the saying, “Do it right, or do it again.” As patients or people with lived experience, let us help you do it right (or at the very least, better). We are confident we can save you a few “Plan, Do, Study, Act (PDSA)” cycles.

One important note about 1):

If you have already made a decision or cannot bring this openness to the table, please do not engage us for “input” or “feedback”. If you are not going to listen and sincerely consider incorporating our voice into your action plan, you will only create frustration and disappointment (for both sides: patient and leader/provider).

2.) Include experience in your evidence. We hear a lot about evidence-based decision-making. Information or data about our experiences should be part of that evidence, and we applaud the HQCA for including it in their resources like FOCUS on Healthcare. This is part of the Institute for Healthcare Improvement’s (IHI) Triple Aim, however we feel it is often overshadowed by population health/outcomes and cost.

If we compared the Triple Aim to a game of rock-paper-scissors, we think patient experience would be the paper. While an equal-odds contender, it is not immediately clear how it competes in the game. How could paper possibly overcome rock (hard and heavy) or scissors (sharp)? Never underestimate the underdog, though. When wielded by a skilled competitor who sees the potential in paper’s role, paper can be valuable and powerful (able to win the game as cover over rock). As healthcare leaders, you are in a position to use that “paper”, the patient and lived experience, to its maximum impact and benefit.

3.) Make time to lift up and celebrate those that are listening to and acting on their patients’ feedback. The good news stories MATTER. Far too often, leaders reward good work with silence. They only make time to monitor and criticize those that are not doing their jobs. Make sure your focus is on patient-centred successes.

This can and should happen in a variety of ways. Ideas for how to do this could include:

  • Establish a way to give credit that is meaningful to the individual or team you want to celebrate. It helps to ask how they prefer to receive these kudos. Some appreciate public recognition and others prefer more private acknowledgement. Either way, personalize it. Make sure you provide a specific example of what you appreciated with respect to patient-centredness and what the resulting benefits were.
  • Apply for or nominate individuals or teams for an award. Awards programs like the HQCA’s Patient Experience AwardsRhPAP’s Rhapsody Awards, and Alberta Health Services’ President’s Excellence Awards are just a few examples of formal recognition programs in Alberta that provide opportunities for this. Make time to apply or nominate individuals and teams who are listening to patients and make sure the patient voice can be heard throughout the submission. When we evaluate the Patient Experience Awards submissions, we like to ask, “Where is the patient/client/resident/family?” That helps us make sure the initiatives we are celebrating are truly patient-centred.

Not only do these programs acknowledge the hard work that individuals or teams are doing to deliver patient-centred care, they provide real, local examples to learn from.

Thank you for taking the time to hear a few of our suggestions about how healthcare leaders can “walk the talk” of patient-centredness by listening to and acting on the voice of those you serve. If you have any questions or require additional support, please do not hesitate to ask us. We also want what is best for Albertans with respect to their healthcare.

On the offer to ask us any follow-up questions or share feedback, please feel free to e-mail myself and our team of patient advisors any time at info@hqca.ca. We believe this should always be a two-way conversation.


HQCAMatters is published monthly and presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.

Real patient and family engagement takes courage

On the five-year anniversary of the release of the HQCA’s Continuity of Patient Care Study, Greg Price’s family reflects on their journey to improve continuity of care for Albertans. 

Five years ago, after the courageous decisions made by the Board and leadership of the Health Quality Council of Alberta (HQCA), the Continuity of Patient Care Study was released. Dr. Tony Fields, Chair of the Board at the time, made this statement in the foreword: “Probing this case lets us look closely at specific problems in the system. More importantly, however, it helps us remember that people are at the centre of the healthcare system.

For us, Greg’s family, the experience of being invited to work with the wonderful team at the HQCA, to discuss, learn, and to contribute to the development of the report gave us genuine hope. Hope that we would have some answers. Hope that there may be some real action taken to change things. Hope that others would not face the same terrible fate Greg had.

The experience with the HQCA team, and the report, was foundational for us. We were able to become more than “another grieving family”. Our family’s support for positive change is built on the report’s carefully documented investigation, its thirteen recommendations, and its “lessons learned” for patients and families, providers, and the system.

During this five year journey, we have met a great many wonderful people, doing the very best they can to provide care while their work is much harder than it should be. They face many unnecessary challenges because of the lack of a real system of care. Too often, leaders within the various areas of healthcare, or “silos”, pursue their own (or imposed political) priorities. Priorities that do not align with what we consider the goal:

Everyone—providers, patients and families, leadership, policy makers, etc.—contributing their strengths together, to achieve the patient’s best possible care outcome and experience.

Five years ago, the HQCA team included us, and set a unique and new level of collaborative teamwork to identify opportunities and to provide recommendations for improvement. This model reached well beyond the traditional, very strong boundaries that kept people like us on the outside of “the system”. Five years later, we are encouraged by the growing openness of people at all levels to discuss challenges and to develop solutions together with patients and families.

The HQCA and those that have embraced teamwork models that include meaningful patient and family engagement do remarkable and brave work on behalf of Albertans. However, with that courage comes the on-going risk of negative or defensive reactions that stall, or worse, impede progress entirely.

Some of the report’s recommendations have been implemented, including clarity on the intervals that referrals to specialist physicians need to be acknowledged and acted on, one way or the other, and the strengthening of the standards for after hours care (see the College of Physicians & Surgeons of Alberta’s (CPSA) Continuity of Care standard of practice). Leaders worked together to enable radiologists to initiate the next test (which would have saved Greg valuable time) when the need is evident and necessary to insure timely diagnostic work, while keeping the patient’s family doctor informed.

Our family, Greg’s family, will be forever indebted to the people of the HQCA. Their courageous leadership and respect given to us during our very difficult time changed our family’s course for pursuing and supporting change in healthcare. This model of teamwork is setting new expectations for collaboration, accelerating the positive change of continuous improvement in health care, making it the very best it can be for everyone.

To fully accomplish this goal though, we need Albertans to become informed and join us (read more about how on our Health Arrows website). Only by working together can we shift the needle to align completely with this better care goal, for patients and providers alike.

Thank you,

Greg’s Family


HQCAMatters is published monthly and presents perspectives on topics or issues relevant to healthcare in Alberta the HQCA considers valuable.