ECFAA provides broader oversight of patient care

Ontario’s Excellent Care for All Act has placed more emphasis on the role of hospital boards and executives in the oversight of patient quality of care, says Toronto health lawyer Michael Gleeson.

“It provides a broader scope for hospital boards to oversee, monitor and enhance patient quality of care,” he tells

“This act focuses on improving quality of care in the health system and doing so in a patient-centric manner. It encourages the system as a whole, and hospital boards in particular, to look at how to improve the experience of patients. And to do that, they have to look at all aspects of patient care. Hospitals should be examining the contributions of all hospital representatives, everyone from administrative staff to nurses to physicians to executives, in order to understand how the overall patient experience can be improved.”

Gleeson, senior corporate counsel at Dykeman Dewhirst O’Brien LLP, says until the new act became law in 2010, the Medical Advisory Committee (MAC) of a hospital was the primary mechanism for a board to ensure that the facility was providing the appropriate quality of care.

“But MACs are made up almost exclusively of physicians and focus purely on issues related to physicians, primarily, and only a handful of other health professionals," he says. "When the Excellent Care for All Act came into play it required a board to establish a Quality Committee, which is a multidisciplinary committee and is comprised of a cross-section of hospital staff, including nursing staff − not just physicians.”

In addition, one-third of the Quality Committee is required to be composed of members from the hospital’s board of directors, bringing the board into direct involvement with quality of care. The board also has an opportunity to appoint any member of the hospital staff to the Quality Committee of the board, as it thinks appropriate, says Gleeson.

Gleeson says that while the mandate of the MAC remains critically important within a hospital, the new act underscores that the MAC has a limited mandate, whereas the Quality Committee has a wider scope. That wider scope may give hospital boards the opportunity to look at some issues related to quality of care that perhaps they weren’t able to look at before, including obtaining direct input from frontline nursing and other health-care staff.

“In the past, there hasn’t been as much emphasis, at the board level, on getting input from the frontline nurses because the MAC doesn’t have jurisdiction over staff nurses. And yet, obviously, the nurses are such an important part of what a hospital does and are an important part of patient interaction — it only makes sense they should be a valuable source of input for the board,” he says.

Gleeson says that the broad scope of information available to the Quality Committee changes the board’s ability to provide oversight for quality of care.

He points out that while the act provides guidance on the mandate of the Quality Committee, and regulations prescribe in part its composition, some hospitals are still tinkering with how the Quality Committee can best be utilized and how the Quality Committee and the MAC should interact in order to best serve the hospital.

“Hospital boards are looking at how exactly these Quality Committees should be used and I think the boards are still getting used to the broad scope of what this committee can be involved with,” he says.

Gleeson has been working with hospital boards so that they have a better appreciation of the responsibilities of the Quality Committee and to make the differentiation between the roles of the MAC versus the Quality Committee more clear so that the boards can use these resources more efficiently.

“The clearer hospitals are on the difference between the roles of each, the better position they will be in to take advantage of each mechanism and use it to the fullest,” he says.

Gleeson says Quality Committees have certain specific obligations, including the review of critical incident data and oversight of the mandated quality improvement plan that has to be submitted annually to Health Quality Ontario by each hospital.

“There are some consistent uses of this committee, but there is also some flexibility in terms of what responsibilities can be delegated to these committees. The responsibilities delegated to the committee may vary, depending on the needs of the hospital, and sometimes both committees may have a role in investigating a quality issue,” he says.

Gleeson says the act outlines general obligations, but how those obligations are put into practice may vary slightly from hospital to hospital.

“Since the act is only about five years old, I think there are probably hospitals out there that are still feeling their way towards understanding how this committee can best be used,” he says.

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