Leadership accountability for quality: A hospital CEO’s perspective

Dianne Doyle, President and Chief Executive Officer of Providence Health Care, Vancouver, British Columbia

When it comes to involving patients in quality improvement, the healthcare profession still has much to learn, says Dianne Doyle.

“We give a lot of lip service in healthcare to involvement of patients, and yet I’m not sure we’ve done a good job in truly involving patients in a way that they can assist us in identifying and improving quality,” says Ms. Doyle. “We haven’t landed yet on what is the best way to engage patients in a meaningful way. We do pieces of it, but it’s not comprehensive.”

When it comes to involving patients in quality improvement, the healthcare profession still has much to learn.

Providence Health Care is the largest Roman Catholic healthcare provider in Canada and Ms. Doyle, a former intensive care nurse, has been at its helm since 2006. Prior to accepting her current position, Ms. Doyle was Vice-President of Clinical Programs, one of many roles she has occupied during her 25-plus years with the organization. Her work has won her many accolades, such as inclusion, in 2007 and 2008, on the Women’s Executive Network’s list of Canada’s Top 100 Most Powerful Women in the Public Sector.

Although Ms. Doyle says that health providers need to engage patients more effectively, she notes that they are making an effort. Surveying people about their care experiences after they leave hospital settings is one way health providers currently involve patients. It is also common to have patient members on healthcare committees, though providing feedback on healthcare to a room of healthcare professionals can be an intimidating experience. These types of feedback tools are valuable,
says Ms. Doyle, but healthcare providers can still do more. One way would be to solicit feedback from patients while they are still in care instead of waiting until they go home.

“Too often, a team of doctors will gather around a hospital bed and talk over a patient about the case, and they miss a huge opportunity to be in conversation with the patient,” says Ms. Doyle. “They are the ones who know themselves and their bodies the best. There would be more quality improvement opportunities if we were better at engaging the patient in the moment.”

Quality improvement opportunities also arise when healthcare organizations foster a culture of excellence. For this to happen, it is important that medical staff have an environment that allows them to excel. Creating that environment is the responsibility of leadership, says Ms. Doyle. At Providence, medical teams are given what they need to provide patients with optimal care.

“Our role is, through providing structures and resources, to enable them to be high-performing teams,” she says.

Of course, it is one thing to encourage an environment of excellence, but it is entirely different to create accountability structures that ensure standards are met. To make the changes necessary to improve quality, healthcare organizations need to obtain performance information about the care they currently provide. Fortunately, says Ms. Doyle, this practice is now widespread in healthcare.

“Fifteen years ago, organizations that had balanced scorecards were considered innovative. Now that is the standard. It’s an expectation,” she says. “You wouldn’t think of not having key performance indicators that you are monitoring on an ongoing basis.”

Quality is always data-driven, says Ms. Doyle. At Providence, the collection and analysis of performance metrics is emphasized in all healthcare settings, from emergency rooms to long-term care facilities. “If we are going to be serious about the data, then we have to put resources into ensuring that we are collecting, analyzing and reporting, in a relevant way,” she says. “We have a team of specialists that focuses on that.”

It is important that medical staff have an environment that allows them to excel, Creating that environment is the responsibility of leadership.

In fact, Providence has people dedicated to quality improvement at every rung of its hierarchy. There is a quality committee at the board level, the senior team level, the medical staff level and the unit level. There are even quality provisions in the contracts awarded to external companies that provide cleaning services in Providence facilities. “We build in expectations around cleanliness and there are consequences if those standards aren’t met,” says Ms. Doyle.

Each member of Providence’s medical staff is also encouraged to be, in effect, a quality improvement advocate. The organization has an electronic system that allows people to report any “nearmiss” incidents in which they are involved. “If they are involved in a situation with a real error or a potential error, we want them to raise that in the organization so that everyone can learn from it, and so that we avoid having a near-miss become a real incident,” says Ms. Doyle.

Reported incidents are investigated to determine root causes. If a problem area is identified in a particular department, the head of that department will address it. Depending on the nature of the problem, a system change may be in order, or perhaps education on a particular topic is the solution. If the problem lies with an individual, and the rare situation arises in which that person refuses to cooperative with corrective measures, there are consequences.

“Those consequences could go right up to disciplinary action, which could mean removal of privileges in the organization,” says Ms. Doyle.

Monitoring the performance of their staff is something that most all healthcare organizations do, to varying degrees, to ensure patients are receiving high-quality care. The results of such monitoring are much more likely to be positive if an organization puts substantial effort into recruiting and hiring good people. This is the reason Providence Health Care has such effective medical teams, says Ms. Dianne Doyle. It hires people who are equipped to excel.

“They come into the organization with a set of skills and knowledge and then maintain that through professional development. That’s an important foundational piece,” says Ms. Doyle. “We would expect that clinicians and care providers have lifelong learning implemented into their own standards.”


Prince Edward Island tells families, “You’re welcome to stay.”

When CFHI launched a call for applications for its Better Together e-collaborative, Health PEI leadership was in the midst of discussing strategies for implementing patient-experience initiatives.

Read More