McGill University Health Centre (QC)

  • Carolyn Freeman, Co-Director, Office of Quality, Patient Safety and Performance, Cancer Care Mission, McGill University Health Centre, Montréal, Québec
  • Andréanne Saucier, Associate Director of Nursing and Co-Director, Cancer Care Mission and Respiratory Services, Office of Quality, Patient safety and Performance, Cancer Care Mission, McGill University Health Centre, Montréal, Québec 

A Key Approach to Ensure Excellence in Cancer Care at the MUHC

In practice, in cancer care at the McGill University Health Centre (MUHC) we have had only limited information about the quality of the care we provide to our patients and for the most part do not know how our outcomes compare to other centres. With the creation of the Cancer Care Mission at the MUHC in 2006 we developed a vision of having quality and performance become central to all we do, our “way of doing business”.

Our Challenge
Promoting and supporting the engagement of clinicians and decision makers in monitoring specific quality and performance indicators and leading improvement projects is the essence of our Intervention Project (IP) that is expected to serve as a prototype for the proposed organizational transformation promoting performance improvement, best practices, learning through knowledge transfer, and research.

Our Strategy
As has been repeatedly shown by high performing institutions, successful transformation requires intervention at multiple levels. Consequently, our project while primarily targeted at front-line clinicians and decision makers (micro level) involves also interventions at the level of the cancer care program (meso level) and is aligned with the quality and performance transformation at the MUHC (macro level).

Our Interventions
In order to achieve our goal we identified the need to put in place structures (capacity) and processes (capability) to support quality and performance improvement efforts including:

  • Clear accountability (clinical governance) of the Quality and Performance Improvement Office (QPIO) of the Cancer Care Mission
  • An infrastructure for collecting, tracking and reporting indicators in a dynamic quality and performance dashboard
  • A well defined framework for quality improvement, adapting principles from different frameworks: project management, knowledge to action, PDSA cycle, performance improvement cycle
  • Interprofessional Improvement Teams (IITs) to lead improvement projects
  • Education, training and coaching for clinicians and decision makers to increase knowledge and skills about effective change, project management and other methodologies
  • A tool for ongoing assessment of contextual factors that may influence the success of quality improvement projects
  • Key people leading change at all levels of the organization in order to sustain change.

The Lessons Learned
For us, the most important lesson was learning to appreciate, value, and respect differences between professional groups and indeed to capitalize on them. We found this to be true at every level, that is, between the two EXTRA fellows and between the members of the QPIO and the ITTs.

In order to sustain a high level of performance we have identified the need to:

  • Assure adequate support of clinicians, including protected time
  • Consolidate human resources, specifically project manager and knowledge brokers
  • Put in place tools of routinization, such as clinical guidelines and continuous mechanisms of surveillance and feedback
  • Work with the Directors of the Departments of Quality and Transition to develop a dissemination plan and similar structures in other clinical missions at the MUHC.