Patients, Families and Providers Work Together to Improve Safety and Quality

The Challenge: Lack of safety and quality indicators that reflect both the patient perspective and a rehabilitation-specific setting

Standard measures of quality and safety tend to be macro-level indicators with a focus on acute care. Typically, they are not representative of other healthcare settings, such as rehabilitation. Nor do these measures necessarily reflect patients’ conceptualizations and experience of high quality care.

The Improvement Project: Building consensus to prioritize and measure relevant safety indicators

Dr. Gaetan Tardif and his team at the Toronto Rehabilitation Institute – University Health Network (Toronto Rehab), engaged a full range of stakeholders, including patients, families, staff members and leaders to develop safety indicators that are reflective of and relevant to a rehabilitation environment. Focus groups were held to better understand the concerns of these key stakeholders and to determine safety priorities. Then, through a consensus-building forum, the groups prioritized to select eight safety areas for measurement.

The Result: Patient and family-centered rehabilitation “safety scorecard”

The result was a safety scorecard that incorporates measurement tools already in place via other reporting mechanisms used throughout Toronto Rehab, amalgamated into one easy-to-use scorecard. This scorecard focuses specifically on the eight safety issues identified by patients, families, and providers that are relevant to the rehabilitation community. The scorecard was pilot tested for six months within a large clinical program.

Over this period, focus groups and facilitated discussions in the areas of quality improvement, performance measurement and patient engagement were held with patients, families, staff, and leaders to establish a framework that reflects the types of infrastructures and supports required for ongoing patient and family engagement in quality and safety initiatives at Toronto Rehab. While the format of the discussions varied, the response from stakeholders did not: “We need to do more of this!” This project exemplifies the UHN strategy of ‘Patients as Partners’ to engage all stakeholders in meaningful ways.

The Impact

The safety scorecard will continue to guide improvement processes within the intervention program. Discussions are currently underway among senior leaders to determine how best to introduce this scorecard across all clinical programs at Toronto Rehab.

While the scorecard is specific to a rehabilitation setting, the engagement methods used to develop and sustain it may be adapted by other programs that are also interested in developing similar local and relevant indicators to guide improvement.

Gaetan Tardif imageDr. Gaétan Tardif
Medical Program Director
Rehabilitation & Post Acute Care and Physiatrist-in-Chief
Toronto Rehabilitation Institute
Toronto, Ontario


Photo at top of page: (clockwise from left) Carol Fancott, Advanced Practice Leader, Patient Safety, Angie Andreoli, Physiotherapist and Research Coordinator, and Dr. Gaetan Tardif, Medical Program Director, Rehabilitation & Post Acute Care and Physiatrist-in-Chief, with research participant, Nancy Xia, Toronto Rehabilitation Institute, University Health Network, Toronto

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