Health System Integration and Sustainability Improving Ontario’s health care system

Noah Ivers, Women’s College Hospital
Noah Ivers, Women’s College Hospital

Ontario Healthcare Implementation Laboratory


  • Research has shown that not all patients get the best possible health care. This means that even when doctors are doing what they think is best, some patients end up less healthy than they could be.
  • Health Quality Ontario (HQO) wants to help doctors, nurses, and other health care professionals provide better care so that all Ontarians are as healthy as possible. One way that HQO does this is by providing doctors with information about how their practices compare to those of other doctors, and research has shown that providing this kind of feedback can lead to improvements in care. However, the size of these improvements depends on how the feedback is presented, and what additional tools or resources are available to the doctors and their patients. It is not known whether these improvements last, or whether people will eventually slip back into their old ways of doing things.


  • As Health Quality Ontario continues to send feedback to doctors around the province, there is an opportunity to test different methods of maximizing these kinds of improvements in care. HQO also helps with programs to make sure that the province’s health care system pays for health care that matches what patients need, when they need it. If the province pays for best practices, known as ‘quality-based procedures’, more people in Ontario should get the right care, at the right place, and at the right time. This would make Ontarians healthier and might also save tax dollars. However, sometimes shifting to quality-based procedures can fail to work or can have unwanted effects. It’s important to carefully study how these programs affect health care.
  • Our team of health care providers, patient partners, and researchers from Ontario and beyond, are working with Health Quality Ontario to study and improve their programs and are supporting HQO in the development of a world-class program in patient-centred quality improvement. Our research will help to ensure that the Ontario health care system works better for Ontarians, and will also help health care systems from around the world learn from Ontario’s example.

Patient engagement

  • The investigative team is using a number of approaches to engage patients in every aspect of the project:
    • Our team includes the Director of Patient Engagement at Health Quality Ontario, who facilitates the involvement of patients and caregivers throughout the project.
    • The research team also has the benefit of an investigator who has lived experience with the health care system (i.e. a patient-investigator) and experience working with both HQO and Patients Canada, a patient-led, patient-governed organization dedicated to bringing the patient voice to healthcare.
    • We are working with HQO’s Patient, Family, and Public Advisors Council to capitalize on their prior work.
    • The project team has partnered with Choosing Wisely Canada, who have worked with numerous patient groups to develop evidence-based patient materials. These materials will be refined with further input from patients representing vulnerable groups and disseminated as part of the study interventions.