EDITORIAL

A message from the Editor-in-Chief Kevin Mercer, MA, FCCHL, is the is a private consultant who works in Kitchener, Ontario

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ichael Porter and Elizabeth Teisberg, in their book Redefining Health Care, maintain that high-quality healthcare should be less costly than lower-quality or status-quo healthcare. In fact, their research suggests that quality and cost usually improve in a parallel relationship. However, traditionally in healthcare, it is generally believed that cost and quality exist as “trade-offs.” Porter and Teisberg believe that, if healthcare organizations are continuously advancing best practices, then quality would be increased and costs would be reduced.

The authors refer to the positioning of an organization in terms of the continuous pursuit of best practices as the “productivity frontier.” Pushing to the outer edges of the “frontier” will drive improved “outcomes at the same cost or attaining better outcomes at lower costs.” Conversely, failure to be driving to the edge of the productivity frontier through the use of best practices results in higher spending with little expectation of improved outcomes. In this edition, we are bringing you a series of articles that represent stellar examples of best practices that have been introduced in Canadian healthcare organizations and are resulting in improved outcomes and efficiencies. They are examples of improvement initiatives that clearly position the organization at the edge of the “productivity frontier” or, at the very least, moving positively in that direction. Our lead article by Chattergoon et al. provides a step-by-step description of how the Toronto East General Hospital shifted the organizational culture to one of continuous improvement. Through an evidence-based approach to problem identification and problem solving, the hospital has shifted its organizational culture and improved quality of service. Specific projects related to emergency department wait times and medication administration proved the value of team-driven performance management. Through the incorporation of improvement methodologies used by Toyota, TEGH moved to the “productivity frontier.” Smith et al. share their experience in applying performance management tools in motivating frontline workers to lead change. The article provides an in-depth understanding of how the interventions introduced by Alberta Health Services reduced the variability in program performance in the provincial hip-and-knee replacement program. Consistency in metrics for all quality dimensions of the program were noted once standardized integrated care pathways were introduced and frontline teams were engaged to develop the improvement plans. St. Michael0 s Hospital shares its experience in driving wholesale changes in their reprocessing/sterilization department. This is an impressive overview of a very tactical and strategic approach that was introduced to improve overall quality. This is a concrete, textbook example of staff engagement to foster support for new performance and quality standards. Prince and Willett write about a mental health and addictions quality initiative and public reporting. They remind us that transparency and enhanced quality monitoring on system quality indicators is not just occurring in acute care but is happening in mental health and addictions as well. The authors provide an update on the Mental Health and Addictions Quality Initiative and the progress on the development of standardized indicators that are currently agreed upon by the stakeholders. Data collection and the accompanying decision support tools can often be an organizational frustration if the business intelligence provided is “out of date” or the information is not “credible.” Famure et al. provide an interesting insight into the development of an information management practice developed at Toronto General Hospital. Through the development of the Comprehensive Renal Transplant Research Information System, a standardized database for quality assurance and research was established. The system is foundational for advancing improvement initiatives and is an information management system that can be incorporated in other similar programs in Canada. There is an excellent array of articles in this edition from individuals and healthcare organizations pushing the “productivity frontier.” Where are you and your organization in terms of the “frontier?” Let us know your thoughts—send us an article describing the leading/best practices that you or your organization are advancing. In sharing your successes, the collective “frontier” is constantly being redefined.

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Healthcare Management Forum  Forum Gestion des soins de sante – Spring/Printemps 2014

A message from the editor-in-chief.

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