Bill 46 - Excellent Care for All

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Health Law Bulletin
May 2010

On May 3, 2010, the government of Ontario introduced Bill 46: Excellent Care for All Act (the "Bill"). The Bill is aimed at making health care providers and executives accountable for improving patient care. The Bill passed second reading on May 12, 2010 and is currently before the standing committee on justice policy. It is possible that the Bill could pass third reading before the house rises for the summer.

Requirements for Health Care Organizations

The focus of the Bill is continuous quality improvement in the hospital sector. In its current form, the Bill defines "health care organization" as a hospital within the meaning of the Public Hospitals Act. The Bill also allows for the designation of other entities as health care organizations by way of regulation. If this legislation operates successfully in hospital settings, the government may choose to use regulations to extend the reach of the Bill to other organizations.

The Bill, as currently drafted, requires the following of health care organizations (ie public hospitals):

Quality Committee

Hospitals must establish a quality committee responsible for:

  • monitoring and reporting to the responsible body (ie its board) on issues of quality of services;
  • making recommendations for quality improvement;
  • insuring that best practices information supported by available scientific evidence is distributed to persons providing services within the health care organization;
  • overseeing the preparation of annual quality improvement plans; and
  • carrying out any other responsibilities provided for in the regulations.


Hospitals must perform surveys at least every fiscal year. The purpose of the surveys is to collect information concerning satisfaction with the services provided by the hospital, collect information on the satisfaction of employees and solicit the respondents' views about the quality of care provided by the organization. Those surveyed will include:

  • people who have received services in the past 12 months;
  • caregivers of people who have received services in the past 12 months; and
  • employees.

Patient Relations Process

Hospitals must develop a patient relations process. The information about the process must be available to the public and must reflect the content of the organization's patient declaration of values.

Patient Declaration of Values

Hospitals must develop a patient declaration of values based on consultation with the public.

Annual Quality Improvement Plans

Hospitals must develop a quality improvement plan for the next fiscal year and make this plan available to the public. The quality improvement plan must be developed having regard to, at a minimum, the results of the surveys, data relating to the patient relations process, and its aggregated critical incident data. The quality improvement plan must contain annual improvement targets and information concerning the manner and extent to which executive compensation is linked to achievement of those targets. The hospital's LHIN will have a right to review the plan before it is adopted by the hospital.

Performance Based Compensation

Hospitals must link executive compensation to the achievement of the performance improvement targets set out in the annual quality improvement plan. The Bill also speaks to how to reconcile the requirements of the Public Sector Compensation Restraint to Protect Public Services Act, 2010, (the "Restraint Act") which froze compensation plans, with the requirement that executive compensation be changed in order to be linked to achievement. The combination of the Restraint Act and this Bill means that hospital executives could face cuts to their compensation unless their organization achieves the performance improvement targets that are set out in the annual quality improvement plan. An issue arises as to whether compliance with this obligation will give rise to a claim for constructive dismissal by an executive.

Expanded Mandate for Ontario Health Quality Council

In addition to the above requirements for hospitals, the Bill would also expand the mandate of the Ontario Health Quality Council (OHQC) to promote evidence-based care in the health care system.

The Bill, if passed, would expand the OHQC's mandate to include:

  • providing recommendations to the health system on clinical practice guidelines and protocols; and
  • providing recommendations to the Minister concerning funding for health care services and medical devices.

What these reforms would mean for Ontarians

In a power point presentation issued by the Ministry of Health and Long-Term Care, the provincial government stated that if this Bill becomes law;

  • providers would be more responsive to patients;
  • providers would be supported with the best evidence to continually improve the quality of care they deliver;
  • health organizations would put the patient experience at the centre of their operations;
  • funding and compensation would reflect quality and value; and
  • Ontarians would have more information and more choice over their health care.

These are all worthy objectives to be sure. As the Bill progresses through the legislative process, it will be interesting to see to what extent these objectives are realized and to what extent the Bill can live up to its name and provide a framework for Ontario to move towards Excellent Care for All.