Medical Matters: Quality improvement in the busy physician’s practice: Nuisance or necessity?

Read time: 3 minutes

By Dr. Charl Els, Assistant Registrar, Continuing Competence

Our healthcare system is under considerable strain and Canada’s physician shortage has only added to the pressure—practitioners report they’ve never been busier or more stretched. Although a central part of good medical practice is the commitment to lifelong learning, quality improvement (QI) approaches are still relatively new in the core education of healthcare professionals. One may ask: In our currently stressed environment, is now really the time to focus on QI?

It is exactly in this complex and stressed environment that a focus on QI may have its most robust impact. Even a basic QI project can enhance clinical governance, increase transferrable skills in communication, improve one’s own personal growth and development, or enhance leadership skills and team functioning, resulting not only in safer and more effective patient care, but also in improved physician health and wellbeing, empowerment and productivity. QI equips physicians with the tools to continue providing high-quality care, even during some of the most demanding times.

Before assuming my role at CPSA, when I was still in clinical practice, I was unsure how to meet the Physician Practice Improvement Program (PPIP) requirements. While I understood that PPIP was designed in part to fulfill the Health Professions Act (HPA) requirement that all regulated members participate in ongoing competence activities, I was not yet convinced of the utility. That changed when I was confronted with a somewhat uncomfortable observation in my own practice: as I was performing a mental and behavioural Independent Medical Examination (M&BD IME) in a medico-legal case, I inadvertently omitted a key piece of information in the history-taking, and further, my assessment appeared to lack a requisite degree of objectivity.

There it was. I had my QI project “cut out” for me! I had already identified a problem area and an opportunity for improvement, so I formulated a PDSA (plan-do-study-act) and decided to commit some time to look into it. I approached a colleague with similar practice experience and we developed a SMART (specific, measurable, achievable, relevant, and time-bound) aim. My newly-assembled team and I looked at the current process for IMEs and analyzed 10 previous medico-legal reports. We looked at the degree to which these M&BD IME reports measured up to the highest standards for these assessments.

Following our review, several learnings were immediately evident. As a result, we implemented changes to ensure that no key elements in the legal reports would be missing, and that a sufficient degree of objectivity was built into the assessments. Seeing that much of the work had already been done, we felt we may as well write this up and submit the findings of our QI learning to a peer-reviewed journal for consideration. Not too long after, it was published as a best practice guideline for M&BD IMEs. What started off as a distinctly humble QI project stemming from an embarrassing oversight in my own practice, resulted in an exciting and impactful journey for both my team and me.

Improving quality means improving safety, effectiveness and experience of care for patients. By applying a systematic approach and using our understanding of our own complex environment, we can design, test and implement changes for improvement. This is exactly what PPIP asks of regulated members: incorporate each of the following three activities into our practices at least once over a 5-year cycle:

• A practice-driven QI activity using objective data;
• A CPSA Standard of Practice activity; and
• A personal development activity.

With these QI projects, the good news is, many of the activities you’re already performing for MOC and Mainpro+ credits may also be used towards meeting the PPIP requirements. No project is too small or too narrow—the focus is improving quality, one small step at a time.

If you have questions about PPIP requirements or are unsure where to start, we’re here to help. Our PPIP team members at CPSA have created resources to help guide you through the PPIP process. If you practice in a clinic, PCN or group setting, our PPIP team also offers presentations—in-person or virtually—to answer questions about the program. Plus, our team has been developing a series of brief videos to help navigate this journey:

• PPIP: The Why with Dr. Shelley Howk
• PPIP: The What with Dr. Sam Lou
• PPIP: The How with Dr. Danielle Michaels

Learning is at the heart of medicine, and, more than anything, we want these QI learnings to be valuable—for you, for your practice and for your patients. As always, we appreciate your commitment to quality care and look forward to hearing about your QI experiences!

Dr. Charl Els joined the CPSA team in 2021 as a Senior Medical Advisor and has since moved into the role of Assistant Registrar, Continuing Competence. He is an addiction psychiatrist and occupational physician, and the recipient of a QE II Platinum Jubilee award for his contribution to mental health and addiction in Alberta.