Appendix 8: Health Quality Ontario Quality Improvement Resources
To facilitate quality improvement initiatives in Ontario HQO has developed a comprehensive Quality
Improvement Framework that brings together the strengths of several QI science models and
methodologies, such as the Model for Improvement from the Institute for Healthcare Improvement (IHI), and
traditional manufacturing quality improvement methods like Lean and Six Sigma. HQO grounded their
framework in Deming's System of Profound Knowledge to ensure a system-wide view of improvement would
be applied to any quality improvement initiative, in any healthcare sector.
Quality Improvement Primers
In addition to the above noted framework, HQO has developed Quality Improvement Primers to give
healthcare teams and organizations in Ontario easy access to well-established QI tools. Each primer is
designed to support the steps of your QI journey.
Quality Improvement Science
A systematic approach to making changes that lead to better patient outcomes and stronger health
system performance. This approach involves the application of QI science, which provides a robust
structure, tools and processes to assess and accelerate efforts for the testing, implementation and
spread of QI practices.
Quality Improvement Team Development
A well-designed QI initiative includes frontline, interprofessional teams that are empowered to: set
goals for improvement, identify causes of poor system quality, conduct tests of change, and collect
and analyze data to determine whether a change led to improvement.
Voice of the Customer
The 'Voice of the Customer' is the idea that the wants and needs of the customer are
central to any business or service. This concept can be seen in several QI
science models and methodologies such as Lean and Six Sigma.
Measurement in quality improvement allows a Quality Improvement (QI) team to demonstrate
current performance (or baseline), set goals for future performance, and monitor the effects of
changes as they are made.
Change Concepts and Ideas
There are many kinds of change that will lead to improvement. Change concepts stimulate critical
and creative thinking, which lead to inventive and specific improvement ideas. Many change
concepts come from the manufacturing industry, but are also applicable to the healthcare system.
This primer addresses the principles and practices of change management and its application to
quality improvement. It is intended to be used as a guide for the design and implementation of
successful change efforts, and to better understand how individuals, teams and organizations shift or
change from a current state to a future state.
Implementing and Sustaining Changes
This primer will focus on strategies for the successful implementation of your improvements and
address concepts for ensuring their sustainability.
After QI teams have made it through the first five phases of HQO's QI Framework, they are ready to
'spread' the improvements that they have made.
Quality Compass is an evidence-informed web-based tool to promote the uptake of best practices to help
support healthcare leaders and providers make sustainable improvements to transform Ontario's healthcare
It provides access to evidence informed best practices and change ideas, indicators and targets, measures, and success stories, contextualized to Ontario designed to inform action and improve care in priority health care areas.