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How big does a PPIP activity have to be?

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April Messenger 2023 | Posted April 13, 2023
Read time: 2 minutes

As members of the Physician Practice Improvement Program (PPIP) team, we present regularly to CPSA regulated members and their support teams about PPIP requirements. Under PPIP, three quality improvement activities must be completed at least once every five years:

  • One in personal development
  • One related to a CPSA standard of practice
  • One using objective data from one’s practice

All physicians have access to some data about their work and their adherence to our standards of practice, along with their own opportunities for personal development. With PPIP, physicians can use this to continuously improve their practice for the benefit of their patients.

A visual representation of the three quality improvement activities that must be completed at least once every five years as part of PPIP: one in personal development, one related to a CPSA standard of practice and one using objective data from one's practice.

Quality improvement vs. quality assurance

Members often ask us how “big” an activity has to be to meet a PPIP requirement.

To understand how quality improvement works, let’s first consider what a quality assurance assessment involves. This is the type of assessment we are all familiar with: if a certain passing mark is achieved, then no additional action is needed. Given that most physicians practising in Alberta already provide good care, most do not require any remedial action from a quality assurance assessment.

Quality improvement requires improvement efforts at every point, recognizing that even when performance is already good, it can still be better. Quality improvement has been adopted as a national and international standard because it requires action taken on all occurrences, thus yielding larger change than seen with simple quality assurance processes.

The bell curves below illustrate the magnitude of shift with a quality improvement approach compared to quality assurance. From small and individual activities to larger, health system-focused activities, quality improvement is a lens or a mindset rather than a predetermined size, all with the potential to yield significant change.

Two graphs comparing quality assurance and quality improvement.
Source: Scoville and Lloyd, IHI, as cited in Rehn and Kruger 2014

It is important to note that these curves shift when each physician takes their own, meaningful steps to improve their practices. These small, individual actions ultimately yield large aggregate improvement in quality of healthcare for Albertans overall.

Small actions improve overall quality

A scatter plot showing overall quality improvement.

As demonstrated by the chart above, by taking small individual and group actions, we shift the curve—not all quality improvement activities result in improved quality, but all together, they shift the curve in the correct direction.

So how “big” does an activity have to be to qualify for PPIP? There are no bounds on the size of your activity. You may have to adjust the scope of your quality improvement activity based on the data available to you, but any such activity can contribute to improving healthcare quality for all Albertans.

As a reminder, PPIP applies equally to CPSA regulated members across Alberta, whether they are in an urban or remote location, in solo or group community practice, or affiliated with an academic institution. Participation is required whether members provide direct patient care or work within health care in another role, and these activities must be reported annually on your renewal information form (RIF). You have at least until 2026 to complete your first set of three activities.

To find out more about PPIP and your responsibilities, please visit our website and don’t hesitate to email us at with your questions.

For a brief overview of PPIP and its requirements, click to watch the video below.

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