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Indicators & Change Ideas

Are you looking to improve the issues facing today’s health care system?

 

Explore the quality indicators being tracked by health care organizations in Ontario through Quality Improvement Plans (QIPs) and change ideas to help improve them. Connect with others to share your experiences and ideas of your own.

INDICATORS & CHANGE IDEAS

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Planetary health

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Sustainability is a core component of high-quality care, and the need to incorporate a “green lens” and embed environmental sustainability into quality improvement efforts has never been more evident.

Be it through reducing low-value, carbon-intensive care, selecting more climate-friendly medication options when clinically appropriate, training and educating the workforce toward environmental sustainability and resource stewardship, or adopting reusables in lieu of disposables, there are myriad approaches to advancing high-quality, low-carbon, and sustainable health systems.

As you work on quality improvement initiatives, it’s important that you integrate a focus on environmental sustainability and climate stewardship in your indicators.

This tile was developed in collaboration with CASCADES: Creating a Sustainable Canadian Health System in a Climate Crisis, a pan-Canadian initiative that strengthens the capacity of the healthcare community across Canada to transition towards, high-quality, low-carbon, sustainable and climate resilient care. CASCADES is funded by funded by Environment and Climate Change Canada.

CASCADES_Navy_bilingual-horizontal638739448262014754

Key Resources:

  • Journal article: Planetary health care: a framework for sustainable health systems
  • CASCADES’ playbook: Training for Better Health Outcomes: Integrating Sustainability into Healthcare Quality Improvement Education
  • Journal article: Bringing Environmental Sustainability into the Quality Agenda: Time to Act on Reducing Health Care Pollution and Waste (Sherman and Singh, 2023)

Change Ideas

Medication optimization

  • Eliminate use of desflurane as an anesthetic agent
    CASCADES’ playbook: Sustainable Perioperative Care Playbook
    CASCADES’ YouTube video: Sustainable Perioperative Care- Eliminate Desflurane at North York General Hospital
    CASCADES’ project charter: Eliminate desflurane
    Journal article: Developing a quality improvement project to tackle the desflurane problem
    Indicator examples
    % of total anesthetic agents purchased that is sevoflurane (desired direction:↑)
    % of total anesthetic agents purchased that is desflurane (desired direction:↓)
    % of patients who were given a non-desflurane anesthesia (desired direction:↑)
    % of staff educated about environmentally friendly gasses (desired direction:↑)
  • Follow the sustainable prescribing pathway for inhalers
    CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Inpatient Care
    CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Outpatient Care
    CASCADES’ collaborative: Climate Conscious Inhaler Prescribing Collaborative
    CASCADES’ course: Climate Conscious Inhalers Prescribing Course
    Indicator examples
    # of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
    # of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
    # of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
    Indicator examples
    % of patients using inhalers with a confirmed diagnosis of asthma or chronic obstructive pulmonary disease (COPD) (desired direction:↑)
    % of patients using inhalers with well-controlled disease (desired direction:↑)
    # of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
    # of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
    # of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
    % of patients using inhalers with observed proper technique (desired direction:↑)
    % of patients using inhalers instructed on proper disposal methods (return to pharmacy) (desired direction:↑)
    # of inhalers prescribed per visit (for acute care) (desired direction:↓)

Food infrastructure

  • Implement plant-forward menus
    CASCADES’ Playbook: Food Infrastructures for Planetary Health
    Journal article: Food is medicine: actions to integrate food and nutrition into healthcare
    The Planetary Health Diet - EAT Forum
    Indicator examples
    % of plant-forward meal options for patients relative to all meal options (desired direction:↑)
    % of plant-forward meal options for visitors and staff relative to all meal options (desired direction:↑)
    % of patients counselled on the health benefits of plant-forward diets (desired direction:↑)

Health workforce preparedness

  • Build internal capacity
    CASCADES’ course (~20 min- asynchronous): Orientation to Sustainable Health Systems
    CASCADES’ course (~ 90 min- asynchronous): Introduction to Sustainable Health Systems
    CASCADES’ course (4 hours, synchronous course): Fundamentals of Sustainable Health Systems
    Indicator examples
    % of staff educated on resilient, low carbon and sustainable health systems (desired direction:↑)
    % of staff that completed CASCADES' Introduction to sustainable health systems learning module (desired direction:↑)

Leadership and governance

  • Engage senior leadership and enable governance structures for sustainability reporting
    CASCADES’ playbook: Organizational Readiness Playbook
    Interior Health’s Roadmap: Climate Change and Sustainability Roadmap 2023–2028
    Vancouver Coastal Health’s Planetary Health Strategy: Vancouver Coastal Health Planetary Health Strategy 2024-2029
    Fraser Health’s Planetary Health Strategy: Fraser Health Planetary Health Strategy 2023-2028
    NHS England’s roadmap: Delivering a net zero health service | National Health Service
    Indicator examples
    Has sustainability been formally integrated into one or more leadership roles? (Y/N)
    # of leadership roles with a formal sustainability component (desired direction:↑)
    % increase of leadership roles embedding sustainability as a formal component and responsibility (desired direction:↑)

Reusables

  • Replace single-use items with reusables where appropriate
    CASCADES’ playbook: Sustainable Perioperative Care Playbook
    CASCADES’ playbook: A reusables first approach to healthcare procurement
    Indicator examples
    Has your organization launched, progressed, or sustained initiatives to replace single-use items with reusables (e.g., isolation gowns, incontinence pads, anesthesia equipment, reusable bags) within the last year? (Y/N)

Planetary health

0 Comments

Sustainability is a core component of high-quality care, and the need to incorporate a “green lens” and embed environmental sustainability into quality improvement efforts has never been more evident.

Be it through reducing low-value, carbon-intensive care, selecting more climate-friendly medication options when clinically appropriate, training and educating the workforce toward environmental sustainability and resource stewardship, or adopting reusables in lieu of disposables, there are myriad approaches to advancing high-quality, low-carbon, and sustainable health systems.

As you work on quality improvement initiatives, it’s important that you integrate a focus on environmental sustainability and climate stewardship in your indicators.

This tile was developed in collaboration with CASCADES: Creating a Sustainable Canadian Health System in a Climate Crisis, a pan-Canadian initiative that strengthens the capacity of the healthcare community across Canada to transition towards, high-quality, low-carbon, sustainable and climate resilient care. CASCADES is funded by funded by Environment and Climate Change Canada.

CASCADES_Navy_bilingual-horizontal638739448262014754

Key Resources:

  • Journal article: Planetary health care: a framework for sustainable health systems
  • CASCADES’ playbook: Training for Better Health Outcomes: Integrating Sustainability into Healthcare Quality Improvement Education
  • Journal article: Bringing Environmental Sustainability into the Quality Agenda: Time to Act on Reducing Health Care Pollution and Waste (Sherman and Singh, 2023)

Change Ideas

Medication optimization

  • Eliminate use of desflurane as an anesthetic agent
    CASCADES’ playbook: Sustainable Perioperative Care Playbook
    CASCADES’ YouTube video: Sustainable Perioperative Care- Eliminate Desflurane at North York General Hospital
    CASCADES’ project charter: Eliminate desflurane
    Journal article: Developing a quality improvement project to tackle the desflurane problem
    Indicator examples
    % of total anesthetic agents purchased that is sevoflurane (desired direction:↑)
    % of total anesthetic agents purchased that is desflurane (desired direction:↓)
    % of patients who were given a non-desflurane anesthesia (desired direction:↑)
    % of staff educated about environmentally friendly gasses (desired direction:↑)
  • Follow the sustainable prescribing pathway for inhalers
    CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Inpatient Care
    CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Outpatient Care
    CASCADES’ collaborative: Climate Conscious Inhaler Prescribing Collaborative
    CASCADES’ course: Climate Conscious Inhalers Prescribing Course
    Indicator examples
    # of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
    # of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
    # of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
    Indicator examples
    % of patients using inhalers with a confirmed diagnosis of asthma or chronic obstructive pulmonary disease (COPD) (desired direction:↑)
    % of patients using inhalers with well-controlled disease (desired direction:↑)
    # of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
    # of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
    # of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
    % of patients using inhalers with observed proper technique (desired direction:↑)
    % of patients using inhalers instructed on proper disposal methods (return to pharmacy) (desired direction:↑)
    # of inhalers prescribed per visit (for acute care) (desired direction:↓)

Food infrastructure

  • Implement plant-forward menus
    CASCADES’ Playbook: Food Infrastructures for Planetary Health
    Journal article: Food is medicine: actions to integrate food and nutrition into healthcare
    The Planetary Health Diet - EAT Forum
    Indicator examples
    % of plant-forward meal options for patients relative to all meal options (desired direction:↑)
    % of plant-forward meal options for visitors and staff relative to all meal options (desired direction:↑)
    % of patients counselled on the health benefits of plant-forward diets (desired direction:↑)

Health workforce preparedness

  • Build internal capacity
    CASCADES’ course (~20 min- asynchronous): Orientation to Sustainable Health Systems
    CASCADES’ course (~ 90 min- asynchronous): Introduction to Sustainable Health Systems
    CASCADES’ course (4 hours, synchronous course): Fundamentals of Sustainable Health Systems
    Indicator examples
    % of staff educated on resilient, low carbon and sustainable health systems (desired direction:↑)
    % of staff that completed CASCADES' Introduction to sustainable health systems learning module (desired direction:↑)

Leadership and governance

  • Engage senior leadership and enable governance structures for sustainability reporting
    CASCADES’ playbook: Organizational Readiness Playbook
    Interior Health’s Roadmap: Climate Change and Sustainability Roadmap 2023–2028
    Vancouver Coastal Health’s Planetary Health Strategy: Vancouver Coastal Health Planetary Health Strategy 2024-2029
    Fraser Health’s Planetary Health Strategy: Fraser Health Planetary Health Strategy 2023-2028
    NHS England’s roadmap: Delivering a net zero health service | National Health Service
    Indicator examples
    Has sustainability been formally integrated into one or more leadership roles? (Y/N)
    # of leadership roles with a formal sustainability component (desired direction:↑)
    % increase of leadership roles embedding sustainability as a formal component and responsibility (desired direction:↑)

Reusables

  • Replace single-use items with reusables where appropriate
    CASCADES’ playbook: Sustainable Perioperative Care Playbook
    CASCADES’ playbook: A reusables first approach to healthcare procurement
    Indicator examples
    Has your organization launched, progressed, or sustained initiatives to replace single-use items with reusables (e.g., isolation gowns, incontinence pads, anesthesia equipment, reusable bags) within the last year? (Y/N)
Aaron Miller True