Innovating for impact: Standards and assessments as a catalyst for safer,integrated,people-centred care

The promise and perils of standards and assessment programs

High-quality standards are people-centred, evidence-based, and responsive to patient and workforce safety and quality priorities. Standards serve as roadmaps for leadership, workforce, patients, and families by providing guidelines and best practices to ensure healthcare services are safe, consistent, and equitable across the health ecosystem. The true impact of standards is realized through widespread adoption and use. The language used in standards and assessments shapes mindsets, behaviours, and actions that can channel resources and energy towards improvements and compliance. Assessment programs, such as accreditation, involve independent, third-party evaluations against recognized standards to achieve quality goals. Coupled with quality improvement, capacity-building, and advisory services, assessments can enable individuals with the knowledge and skills needed to design, measure, and sustain a culture of safety and improvement.^3,4

While their potential is significant, standards and accreditation programs carry risks and limitations if they are too narrowly focused on compliance and regulatory requirements rather than fostering a culture of learning and innovation; create significant administrative workloads that divert resources from direct patient care; lack flexibility and fail to account for the diverse and dynamic nature of healthcare settings; operate in silos failing to integrate across different parts of the system; and don’t effectively facilitate the collection and use of high-quality comparable data—which is essential for measuring impact, outcomes, and value.^3-6 To address these limitations, Braithwaite et al. ³ advise organizations to view accreditation as one component of a broader quality management strategy rather than a standalone solution. This perspective aligns with the movement towards learning health systems, which require health leaders to create adaptive and responsive environments that prioritize patient-centred care and drive ongoing improvement and innovation. Such an approach involves continuously integrating real-time data and evidence into practice.^,7

Recognizing the need to innovate and adapt to the future of quality and learning health systems, HSO and AC have significantly evolved over the past 5 years. They have enhanced their standard development processes, assessment practices, and services to foster new approaches that align with people-centred priorities, actions, accountability, and outcomes.

Improving patient and workforce safety

Everyone should have access to safe, high-quality care, no matter where they live or who they are. Everyone who provides care should also be safe and supported, no matter where they work or learn. ²

Innovating healthcare takes new mindsets and practices towards patient and workforce safety. HSO and AC’s approach to safety aligns with the World Health Organization’s Global Patient Safety Action Plan ⁸ which emphasizes the spread and scale of initiatives aimed at reducing adverse events and creating a world where everyone receives respectful and safe care. As active participants in this plan and other global agendas for quality, HSO and AC are accelerating the introduction of new safety evidence, best practices, and global learning into the design of standards and assessment programs.

Broadening definitions and expectations about safety are critical to innovating care and moving beyond the outdated notion that safety is achieved solely by the absence of physical harm. The definition of safety within HSO and AC standards and assessment programs has evolved to recognize physical, psychological, and cultural aspects. This expanded view applies to patients, care partners, and the workforce. A more comprehensive definition equips leaders to better address diverse safety needs and foster a safety culture that is inclusive, meaningful, and far-reaching. A significant milestone in this evolution is HSO’s partnership with the First Nations Health Authority (FNHA) to develop a first-of-its-kind British Columbia Cultural Safety and Humility standard. ⁹ This work offers invaluable insights into Indigenous-specific systemic racism in healthcare and underscores the critical role and responsibilities of all healthcare organizations, including HSO and AC, in confronting historical and systemic inequities. As a next step, applying the co-design learnings and appropriate content requirements into the next generation of standards and assessment services will enable leaders to uphold their commitment to providing healthcare services that are culturally safe, respectful, and accessible for Indigenous Peoples.

Partnering with diverse stakeholders to build standards and deliver assessment programs creates a space for new perspectives and a more inclusive reflection of health and safety priorities and practices. HSO’s Governance ¹⁰ and Leadership ¹¹ standards now embed people-centred care requirements that ensure commitment and accountability across organizations and systems. These standards place patients at the centre of care design and delivery, empowering them to be part of shared decision-making. The launch of the Accreditation Canada People-Centred Care Commitment Award in Qatar, highlighted by the Primary Health Care Corporation (PHCC), ¹² illustrates the significance of patient insights in shaping leadership and governance structures. For health leaders, these innovations are crucial because they place people’s needs at the core of healthcare organizations, rather than prioritizing the needs of the system or the organization. In the case of Qatar’s PHCC, the accreditation process enabled patients to contribute to crucial decisions in the design and development of services, enhancing trust and ensuring that care delivery is truly aligned with the communities’ needs and values.

Innovating accreditation practices that move away from the traditional “big-bang” approach and create space for ongoing improvement and learning promotes sustained engagement and accountability and data-driven improvements and enables more responsive and adaptive management of quality and safety for patients and the workforce. In April 2024, AC re-launched its Qmentum Global accreditation program, incorporating a range of annual activities such as self-assessments, attestation, quality improvement action planning, and short-notice surveys. To support these efforts, cloud-based, secure digital platforms are provided, facilitating the implementation and monitoring of action plans, reporting tools, and results dashboards. This comprehensive quality approach ensures that health leaders and organizations have the tools necessary to implement standards of care and work towards common safety priorities and outcomes across various settings. The program includes HSO’s new Global Workforce Survey™ (GWS). ¹³ Co-designed with the workforce and leaders and piloted with over 10,000 individuals across 300 locations, this 65-item survey measures perceptions of work-life and safety culture. It provides measurable and actionable insights in multiple domains, including job expectations, immediate supervision, leadership, work team, well-being and engagement, patient-centred care, and safety. This comprehensive approach ensures that the survey captures a holistic view of the work environment, enabling organizations to identify areas for improvement and implement targeted interventions to enhance both workforce well-being and patient outcomes (Figure 1).OPEN IN VIEWER

Advancing integrated and connected care

Connected and coordinated care is safer care. ⁸ Evidence shows that risks of adverse events are highest during care transitions, ¹⁴ highlighting the need for healthcare leaders to prioritize advancing integrated care through partnerships across the care continuum and organizational boundaries. ¹⁵

Adopting co-designed integrated care standards, customized assessments, and implementation tools, enabled by technology, are essential levers of change within reach for health leaders. These solutions need to accommodate both small rural and large urban settings, as well as diverse populations and geographic locations across multiple settings, networks, and organizations, recognizing that there is no one-size-fits-all approach. HSO’s seminal national standard on Integrated People-Centred Health Systems is based on 10 design principles (see Figure 2) and includes 66 criteria, providing concrete, evidence-informed guidance on what needs to be done, where, and by whom to enable effective partnerships across the continuum of care and organizational boundaries. ¹⁶ Insights and practices drawn from HSO’s 3-year learning collaborative, Improving Integrated Care for Child and Youth Mental Health (IICY), were instrumental in testing the standard and designing HSO’s Integrated Care Maturity Index. This implementation tool helps organizations determine where they are on their integration journey, identify what they are already doing well, and pinpoint areas needing further focus. By leveraging these inclusive and practical tools, health leaders are enabled to advance integrated care to foster stronger, more coordinated, and safer healthcare systems across care sectors.OPEN IN VIEWER

Customized approaches to accreditation, such as the one championed by the Huron-Perth and Area Ontario Health Team (HPA-OAT), demonstrate how organizations are co-leading innovations to focus on patient experience across transitions of care by shifting from a fragmented to a collaborative accreditation approach. ¹⁷ The HPA-OAT strategy leverages standards to harmonize practices, protocols, and procedures across the patient pathway, encompassing multiple sectors, including hospitals, clinics, long-term care, home care, disability, and community support services. By understanding the experiences and outcomes of patients and clients as they navigate through multiple organizations, health leaders, and all partners are better equipped to strengthen the coordination and consistency of integrated care, across sectors, into the future. Saudi Arabia’s SEHA Virtual Hospital (SVH) completed its first fully virtual hospital accreditation in 2023, receiving the highest level of accreditation from AC. This required a collaborative effort between AC and SVH to design a customized and robust assessment manual relevant to the unique context of SVH to enable safer care transitions and high-quality care across the continuum and life span of the population they serve.

Strengthening health of communities

Everyone should have the ability to achieve their full health potential, no matter where they live, what they have, or who they are. ¹⁸

Progressing towards people-centred, equitable, culturally safe, and environmentally sustainable care requires a commitment to inclusive partnerships, innovative approaches, continuous improvement, and a steadfast focus on achieving health and well-being for all. HSO and AC, alongside their clients and partners across the health ecosystem, are taking steps to actively contribute to achieving the United Nations (UN) Sustainable Development Goals (SDGs) ¹⁹ aimed at ensuring healthy lives and well-being for all, at all ages.

In 2022 HSO’s Governance standard, a core standard used by all accreditation clients, was revised and tested to include specific language to stimulate action and accountability on equity issues, Indigenous-specific racism, and environmental stewardship. Embedding these values at the governing level of healthcare is essential to ensure that systemic change is reflected in the care delivered.

In 2023, the release of three new national standards addressing the care and service needs of equity-deserving populations, including people in long-term care, ²⁰ individuals experiencing mental health and addictions challenges, ²¹ and children in pain, ²² has created significant momentum for people-centred care. These initiatives mark a substantial step forward in improving care experiences and outcomes for at-risk populations. In partnership with the National Institute on Ageing (NIA), Mental Health Commission of Canada (MHCC), and Solutions for Kids in Pain (SKIP), each standard was co-designed by technical committees with balanced representation and voting rights for people with lived experience, workforce members, researchers, and policy-makers. Extensive public consultation across various sectors and communities, combined with evidence, shaped the key principles and content of each standard. For example, the standards include requirements based on feedback and evidence that underscored team-based care, upholding people’s autonomy and choices in care decisions, a healthy and competent workforce, equitable and culturally safe care.

The release of the standards accumulated over 4,300 media stories combined and recognition in multiple ministerial speeches. The LTC standard was also profiled in the UN Decade on Healthy Ageing Progress Report, ²³ boosting public and political confidence in the role of quality standards in improving healthcare outcomes, ensuring equity, and fostering systemic change. For health leaders, implementing the standards as part of a quality assessment and learning journey is an actionable and critical step towards building trust and strengthening the safety, equity, and quality of care in an inclusive, transparent, and motivating way.