HealthcarePapers 12(1) April 2012 : 3-4.doi:10.12927/hcpap.2012.22867


Maureen O'Neil

Healthcare systems in Canada do not consistently provide high-quality, appropriate care to users. As a country, we tend toward the middle of the international rankings on health system performance, a standing that creates little urgency to rise to the top. Despite our B-level performance, healthcare quality improvement has begun to take centre stage. The evolution of health quality councils, the creation of charters on improving quality of patient care and the enactment of quality reporting and quality standards legislation by provincial and territorial governments are evidence of a profound recognition that high-quality, patient-centred care is where we need to be. To get there requires collaboration, coordination and leadership.

As an organization that works shoulder to shoulder with policy makers, leaders, providers and patients to create and apply knowledge to improve health services in Canada, the Canadian Health Services Research Foundation (CHSRF) is pleased to introduce this issue of Healthcare Papers, focusing on metrics for high-quality patient care.

In 2010, CHSRF released the first-ever chartbook on healthcare quality in Canada. Quality of Healthcare in Canada: A Chartbook (Sutherland and Leatherman 2010) draws together disparate pieces of data across the quality spectrum. The aims of the chartbook were to present a picture of quality across the country, to celebrate areas where Canada is doing well and to shed light on areas where improvement is needed. The chartbook has been a great success, thanks to a tremendous effort by its authors, Kim Sutherland and Sheila Leatherman, and the generosity of our partners, the Canadian Patient Safety Institute, the Canadian Institute for Health Information and Statistics Canada.

The chartbook has been a jumping-off point for Canada and has contributed immensely to the discussion on metrics for quality improvement. This is evident in the lead paper of this issue (Sutherland et al. 2012) and the commentaries that follow (Corbett 2012; Florizone 2012; Veillard et al. 2012; Watson 2012). The next step must be about addressing limitations of the chartbook, digging deeper into the available data and analyzing data in ways that speak to patients' perspectives. Indeed, we should not assume that current data sets represent each of us; data in aggregate can only tell us so much about the individual. And, perhaps most importantly, quality data and metrics are merely pieces of the quality improvement jigsaw. Reliable data are a necessary input into a broader improvement strategy.

If Aristotle were a present-day healthcare leader, he might say, "We are what we repeatedly do. Healthcare quality improvement, therefore, is not an act but a habit." To rise above B-level rankings, to privilege the patient and public perspectives and to create the conditions for collaboration, quality improvement must be second nature. We must be predisposed to it, as the authors suggest in their response to the commentaries (Verma et al. 2012).

This issue of Healthcare Papers provides an opportunity to confront and discuss the challenges of driving quality and performance in your own organizations and jurisdictions. In setting your sights on delivering high-quality patient care, you are encouraged to use this issue as an opportunity to exchange ideas on how to implement improvement strategies that are evidence driven, effective and sustainable.


Maureen O'Neil, OC
President, CHSRF

About the Author(s)

Maureen O'Neil, OC, President, CHSRF


Corbett, S. 2012. "Incentives Required to Drive Change." Healthcare Papers 12(1): 44–48.

Florizone, D. 2012. "Quality of Healthcare in Canada: Potential for a Pan-Canadian Measurement Standard." Healthcare Papers 12(1): 38–43.

Sutherland, K. and S. Leatherman. 2010. Quality of Healthcare in Canada: A Chartbook. Ottawa, ON: Canadian Health Services Research Foundation. Retrieved January 15, 2011. <>.

Sutherland, K., S. Leatherman, S. Law, J. Verma and S. Petersen. 2012. "Chartbook: Shining a Light on the Quality of Healthcare in Canada." Healthcare Papers 12(1): 10–24.

Veillard, J., C. Gula, T. Huynh and N. Klazinga 2012. "Measuring and Reporting on Quality of Care and Patient Safety in Canada: Focusing on What Matters." Healthcare Papers 12(1): 32–37.

Verma, J., S. Petersen, K. Sutherland, S. Law and S. Leatherman. 2012. "The Authors Respond." Healthcare Papers 12(1): 50–57.

Watson, D.E. 2012. "Can a Book of Charts Catalyze Improvements in Quality? Views of a Healthcare Alchemist." Healthcare Papers 12(1): 26–31.


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