DLSPH Open: Improving Quality with the IDEAS Project
June 12/2019
When we cut health budgets, quality inevitably crumbles. But what if we set out to 
improve quality – and end up saving money in the process?
This is exactly what IHPME researchers at the IDEAS Project have found over the last few years when they helped teams to improve care for more than 150 organizations, including hospitals and long-term care homes. Focusing on delivering the right care at the right time met patient needs and saved money.
With our newly minted Academic Plan still fresh in everyone’s minds, I’d like to highlight this achievement because it exemplifies an important way we plan to grow as a school: applying our deep knowledge of the health system in useful ways and offering more evaluation of how improvement efforts stick, scale and spread.
Take a particularly egregious and common problem: keeping elderly people in hospitals, at a cost of more than $1,000 a day, when they could be receiving care in the community.
At Kipling Acres, a City of Toronto LTC Home, leaders realized that too many elderly people in Etobicoke were staying in the hospital for rehabilitation when the home could provide this care.
Working with the IDEAS Advanced Learning Program, the team participated in learning sessions taught by quality improvement experts. IC/ES consultants helped them with data analysis, and experienced QI improvement coaches from Health Quality Ontario guided them. The critical steps for the Kipling Acres team to achieve their goal included specifying the type of care their convalescent program could handle, introducing a streamlined and electronic application approval process, and improving the hospital discharge process that ensured all patients had a plan.
Not only did streamlined admission processes save the home 240 staff hours per year, but none of the patients during the study period was admitted to an emergency department. An IC/ES study of this project found that improving the efficiency of the transfer from acute to convalescent care at Kipling could save an estimated $3,800 per patient. The analysis also found that rehabilitative care cost, on average, $11,100 less for those treated at Kipling versus a hospital.
Focus on quality and cost will fall into line—this is one of the most exciting insights I’ve seen in my career. It points to a way forward at a critical time in our health system.
We all know the facts: Ontario is facing a growing and aging population. Patients are living longer with multiple complex conditions. More treatments are coming online, and there’s a strong desire—and demand—to bring precision medicine to our patients. All of this is happening amid financial austerity.
But we have the ability to help. As our Academic Plan describes, we are responding to these challenges by committing more research and resources to support our health institutions in finding the nexus of quality and capacity as they navigate a changing health care landscape.
As research academics, we need to make sure quality improvement isn’t an extra – it’s a must-have. We need to improve quality for patients’ sake but also to make our health system sustainable. I can’t imagine a more important win.
Adalsteinn Brown
Dean and Professor
Dalla Lana School of Public Health